FTrevor (a 35-year old musician from Arizona), made an easy decision to undergo a vasectomy. He and his wife have long known that they didn’t want children, so the procedure has always been in the back of his mind.
But after learning about the U.S. Supreme Court’s leaked draft decision to overturn Roe v. Wade—which could still change before it becomes final, likely in late June—“It was like, ‘Why am I holding off at this point?’” Trevor says. “It’s such a big thing that I can take care of for my wife and I so easily, so why not?” Trevor (who asked to use only his first name to protect his privacy) is waiting to learn whether his state-provided insurance will cover the procedure, but says he’ll move forward even if he has to pay for some costs himself.
Many people are considering doing the same, according to anecdotal reports. Google searches for terms like “how much is a vasectomy” and “how to get a vasectomy” surged after Politico The leak was reported on May 2 in particular states like Texas, Utah and Missouri, where abortion access has been under threat.
Searches for “tubal ligation,” otherwise known as tube-tying or female sterilization, also increased significantly after the leak.
Social media is flooded with men requesting vasectomies. “Men, It’s Time to Consider a Vasectomy,” reads a recent Slate headline.
Vasectomies can be performed as a simple surgery. The doctor will cut or block the tube through which sperm flows, preventing sperm from entering semen. It is quick, takes little recovery and has no effect on sexual function. tweeting about his own recent vasectomy—and who says his patient coordinator has noticed more patients calling to ask about the procedure in recent weeks.
For decades, both male sterilization and female sterilization were used to provide safe, effective permanent contraception. Vasectomies were less well-known in the U.S. historically than have been female sterilization. The United Nations estimates that in 2015 there were approximately twice the number of sterilizations performed on women than men.
“I love the concept of vasectomy going viral,” says Oregon urologist Dr. Ashley Winter. “But not for the reasons that have been happening.” She wishes people were seeking out the procedure of their own accord—because she thinks it’s a great option for couples or individuals who don’t want or are done having kids—rather than because of possible limitations on abortion and other reproductive health care.
Winter also concerns about the spread of misinformation online. This includes, some recent social media postsThey have encouraged men to undergo vasectomies, stressing the fact that they can be reversed. While vasectomies can technically be reversed, doing so requires surgery that is much more complex and invasive than the original procedure; it’s also not guaranteed to be successful. Winter tells her patients to think about vasectomy like marriage: though there’s technically an escape hatch, “you should plan for it to be permanent.”
Others have suggested that vasectomies should be mandatory for men who are denied abortion access. These posts may seem funny, but the reality is that they are more serious when you consider the complex history of U.S. permanent contraception. Throughout much of the 1900s, it wasn’t uncommon for doctors to sterilize both women and men (but more often women) without consent or by coercion—especially those with disabilities and from marginalized backgrounds and lower socioeconomic classes. The eugenics movement in America inspired over half of all the U.S. States to pass laws that specifically supported this practice during the first half century.
“Because of its eugenic past, sterilization in the late 1960s and early 1970s was often seen as a procedure for ‘unfit’ women, especially women with disabilities,”says historian Rebecca Kluchin, who wrote a book about sterilization called It is Fit to be Tie.
To correct these atrocities in 1976, the health authorities established new guidelines for sterilization of females through Medicaid. The consent forms were signed by patients who had to be 21 years old. The patient had to follow a 30-day waiting period between signing the consent form and having their operation.
For people who have public health insurance, these rules apply today. Patients and physicians argue that it is an unneeded barrier to healthcare, which applies mainly to patients with lower incomes or higher risk. People who can’t take the time off from work or afford to travel to a medical office twice in 30 days may not get the procedure at all.
True as that may be, the policy “came about as a result of historical injustices against people from marginalized communities who were forcibly sterilized against their will and without consent,” says Dr. Aishat Olatunde, a Pennsylvania-based ob-gyn and a member of the nonprofit group Physicians for Reproductive Health. “This consent form came about to protect those populations, but we do see that it can limit access to receiving permanent contraception.”
Even with consent standards in place, there are still reports of blatant violations, like when a nurse working in a for-profit U.S. Immigration and Customs Enforcement (ICE) facility said in 2020 that doctors working there forcibly sterilized some individuals under ICE’s care. Dozens and dozens of women confirmed that claim, which was eventually shut down by the Biden Administration last year.
Coercion can also be used in more subtle ways. Research suggests that physicians are more likely to suggest sterilization to those from low-income backgrounds. Federal data shows that almost 40% of U.S. women who did not have a high school diploma were sterilized in the period 2017 to 2019. That compares with just 12% among those with college degrees or above. After controlling for factors such as age, marital status and parent status, U.S. women of color have twice the likelihood of being sterilized. However, sterilization rates in women without insurance (or public) are about 1.5 times higher than that of women who have private or non-insured coverage. According to the 2017 American College of Obstetricians and Gynecologists’ (ACOG), report.
“Although they may reflect patient preferences, these differences raise concerns that women do not have equal access to the full range of reversible methods and that low-income women and women of color may be counseled differently about contraception than white or privately insured women,” ACOG’s report says.
On the opposite side of the spectrum, some people who want to be sterilized face resistance from doctors who don’t want to perform the procedure. Federal law gives health care providers the right to decline procedures that are incompatible with their religious beliefs. In 18 states, additional laws allow doctors to reject sterilization procedures.
Even in states without such laws, it’s not uncommon for patients to encounter resistance from physicians who fear they will later regret the procedure, often because of youth or marital status.
While there isn’t much research on the subject, anecdotal evidence suggests young women are more likely to be denied sterilization than young men. Trevor, the man in Arizona planning to get a vasectomy, says his wife has been turned down for tubal ligation five times, while he’s so far faced little resistance in scheduling his own procedure. The “Childfree” thread on Reddit is full of stories from women struggling to get sterilized, and some women report doctors requiring their partner’s permission to go through with sterilization, even in the present day.
A 2011 survey found that almost 60% of U.S. ob/gyns would dissuade a 26 year-old woman from having her tubes tied if her husband did not agree with the decision. 32% stated they would also discourage such a patient, even though her husband is onboard. The percentages for hypothetical patients aged 36 fell to 47%, 10% and 22% respectively. Provider thinking may have shifted in the decade since that study was published, but the problem remained widespread enough for ACOG to address it in its 2017 report, writing that, “Paternalism, in which a physician overrides a patient’s autonomy to ‘protect’ her from the consequences of her own decision making, should be avoided.”
It is possible that some physicians are reluctant to perform certain procedures due to outdated standards. Through the 1970s, U.S. doctors followed what is colloquially called the “120 rule,” under which a woman could not be sterilized until her age multiplied by her number of children totaled 120. (For example, a 30-year-old patient wouldn’t be eligible for sterilization unless she had four children.) While that rule is no longer used today, some doctors remain skittish about sterilizing young patients who don’t already have children.
Jacki Greavu is 30 years old and lives in Montana. She has always known she doesn’t want children, and began asking doctors to tie her tubes when she was 22. She was warned by doctors that she may change her mind and refuse to have the procedure until she turns 30. “They just think if you’re not 30, you’re not old enough to make this kind of decision,” Greavu says.
However, she wasn’t sure and managed to find a doctor willing to help her just weeks short of her 30th anniversary. “I actually bawled inside of his office,” Greavu says. “It was really cool to finally have someone sit down and listen to me.”
Kluchin believes medical paternalism has a strong connection to forced sterilization. While people who are seen as “unfit” for parenthood—usually because of racist, classist, or ableist thinking—may be pressured into sterilization, people stereotypically seen as “good” parents—often young, relatively affluent white women—may be denied the procedure. “It comes down to…some women’s reproduction seen as beneficial, and others seen as detrimental,” Kluchin says. “That’s the continued trend.”
Clavell, the Houston urologist, says he sometimes treats young men who say they’ve faced similar resistance when trying to get vasectomies. It can be difficult to get insurance coverage. While most health plans must cover female sterilization under the Affordable Care Act, the same isn’t true of vasectomies.
Clavell states that he strives to have a practice where patients are always in control. “I am no one to tell you what to do in regards to your body,” he says.
That’s the attitude reproductive-rights advocates wish doctors would take across the spectrum, whether they’re talking about sterilization, contraception, or abortion. If people were trusted to direct their own reproductive health care, medical procedures wouldn’t have to go viral in the wake of a news story, Winter says.
“None of this stuff should be trendy and none of this stuff should be politicized, whether it’s vasectomy, abortion, tubal ligation, none of it,” she says. “All of it is medical care.”
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