Carol “I am watching my 2-year-old for signs of chubbiness because that way lies hoochie-mama-dom” Lloyd* was bad enough, but now Tracy Clark-Flory ups the ante with this wistfully paternalistic little bit in a post about an Alternet piece describing the efforts of a young white woman to get her tubes tied, only to be told over and over that she was too young:
I’ll admit to being torn on this one. It’s an issue of reproductive choice and freedom, to be sure. But making medical and ethical judgments like whether to tie a woman’s tubes (or whether someone is prepared for a sex change) is a doctor’s right and, arguably, an essential part of the job description. On the other hand, when it comes to elective operations, allowing doctors to determine what’s really best for a woman is, of course, an incredibly slippery slope.
The problem is that the refusal is not based on medical or ethical judgments, but simply on the patient’s age (often, regardless of whether she’s had kids; the whole “but what if your child dies” thing is a big factor) and the doctor’s idea that she’ll regret the procedure because women want babies, even if they *say* they don’t. Yet, curiously, this kind of calculus never seems to come into the picture when the elective procedure is meant to enhance a woman’s sexual appeal — only when it allows her to take control over her own reproduction (or, in the case of gender reassignment, to reject the gender role one was born into). And it’s not like there are many long-term birth control options out there — many doctors categorically refuse to fit women who haven’t had children with IUDs. At least there there’s a valid medical reason (certain IUDs can puncture the uterus if there’s not enough room in there, something that generally isn’t a concern once a woman’s had a baby). Young men who want vasectomies often run into the same paternalistic attitude, but I bet that’s got something to do with being “unmanned.”
Of course, a far more interesting response would have been to note that it’s generally only white women, and non-poor white women at that, who have difficulty obtaining tubal ligation — if you’re on Medicaid, the junior Senator from Oklahoma will perform one on you whether you want it or not, and if you’re of color, disabled, or otherwise not the kind of woman the natalists get the vapors about when they don’t reproduce faster than those *other* people, sterilization and long-term birth control will be pushed on you regardless of your wishes.
And that reproductive choice means nothing if all women don’t have all choices, and aren’t trusted to make those decisions for themselves. Ideas about women’s proper role in society — and the particular role of the class the woman the doctor is looking at belongs to — shouldn’t enter into the equation. What should is medical risk, knowledge and acceptance of consequences.
Otherwise, it’s no different than a pharmacist refusing a woman her pills because he thinks sex is immoral.
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* In the post before the one about tubal ligation, Carol Lloyd wrote that, “Stateside, tales from the mommy vs. non-mommy wars have long since failed to engage my curiosity.”
The post before *that*, she argues that women who get beaten by their husbands or exes shouldn’t be involved in child care, because such a woman might be “distracted” from the “emotionally arduous work” of childcare.
I completely agree. When I read the post from Lloyd about not letting women who are being abused work with kids because they might be distracted, I felt sick to my stomach. Aside from the disgust I felt around this particular example (very “she got herself into this mess, she can figure a way out - without a job, so she’s not near my kids!”), it also seemed to argue that child care workers should have no personal life at all - what if someone they loved died, or was sick? That could distract them - fired!
Oh, it’s a choice and all, but you can’t make doctors do it! Gee, great. Where have I heard that before?
Why, why, why do people assume that their own discomfort should be the deciding factor in these situations?
It really lights a fire under me to have people insist that young women will regret having tubals. The snap judgement completely undermines the sort of thought and experience that a woman would have invested in the decision. The fact that it’s a permanent form of birth control isn’t some big secret that just doctors are clued into! We know about this, we think about it, we do actually ask ourselves “what if” before we step into the office. Believe it.
…But here’s something that women who have had tubals can attest to: the sex is awesome. No dark cloud. No worries… which means… better orgasms. It pisses me off to no end that doctors worked so hard to deny me that pleasure for so long.
I made the mistake of reading the comments thread on that Alternet article. I couldn’t figure out how to argue against the typically paternalistic attitudes of so many of those respondants. I just got angry, and thought “That’s so paternalistic.”
Some of the respondants tried to claim that doctors making a decision for a young woman about tubal ligation is equivalent to doctors making the decision that children must have vaccines (never mind the part where that’s a public health issue and usually dictated by community standards, not doctor standards. Oh and not at all equivalent to surgery on an adult).
But of the people insistent that women would regret it, or that doctors “do this sort of thing all the time” … well my brain was so clouded with rage that I couldn’t think through why it was simply wrong.
But you’ve articulated it well for me here. Thanks.
I was denied a tubal ligation in my early twenties because of my age and what my future husband might want, and that denial had far-reaching effects in my life. Reproductive choice is limited to means by which a woman’s fertility is not truly compromised long term, because gawd knows, each and every one of us should push one out for our country or our religion or some such thing.
It is appalling that when faced with a woman, an actual person with actual desires for their own life, a doctor is even allowed to make decisions for her based on supposed desires of non-existent children and husbands that have not, and may never, materialize. It’s ridiculous.
Starting to wonder? I don’t believe in any sort of feminism litmus test, but that jaunty pink scarf sets of my alarm signals. I can’t remember when I last bothered to read it.
I just had a weird thought about this:
I think a lot of people — more than most people will admit — are very ambivalent about having children but eventually decide to do it. It’s hard for them to understand someone who absolutely does not want children, ever, because they think that they went through the same thing and yet decided to have kids anyway. That’s why you get the condescending, “Oh, honey, I felt the same way when I was your age, but now I don’t know how I could have lived without my little Dakota!”
Not to mention that there are people who change their minds about having more kids when they get into a new relationship. It happens. Which, to me, is more a sign that we need better methods of reversible long-term birth control than a sign that we can’t let people make their own reproductive decisions.
Why is it that when people are wasting their time getting their knickers in a knot about how much women are going to regret their current decisions in the future, nobody ever seems to think of all the women who have children and then regret that choice?
“Which, to me, is more a sign that we need better methods of reversible long-term birth control than a sign that we can’t let people make their own reproductive decisions.”
It would be nice if American doctors, at least, weren’t so damn allergic to IUDs when it comes to women who are planning on or open to having more kids at some point. There’s at least one new method of male birth control in the works that sounds really promising–it’s functionally a vasectomy, but it uses a plug instead of surgery. If a man or a het couple change their minds about kids later, the plug gets removed the same way it was put in, for the same price, and off they go. No hormones, no surgery, and virtually no risk of side effects.
preying mantis: because tut-tutting about bad mothers has surpassed baseball as the national pasttime. We’d be ever so bored if women who didn’t want kids were allowed to make sure they, you know… never had kids.
This might be a stupid question from a medical standpoint, but why not make an IUD in a size that would fit more women who haven’t had kids?
I got lucky (so far as I can tell) in that Mirena did fit me even though I haven’t had any children, and my main question is why the hell didn’t a GYN recommend it years ago.
I realize it wouldn’t work for everyone, but more choices = better!
Tricia, I saw a gynecologist when I was in law school to try to get Mirena and she talked me out of it. She claimed that I could get an infection which would cause me to be infertile, and that as a result she would strongly recommend against it, and since I do potentially want kids and was looking for long-term, *reversible* birth control, I was scared off. After reading up on it more, I’m pretty sure that she drastically inflating the risk–but now it would cost me a lot, so I’m stuck with the pill.
I had the same bullshit, Thistle, from my gyno about the Mirena. Utter crap. Yes, if you get Chlamydia or Gonorrhea it basically has an easier route onwards and upwards to cause PID, which can lead to scarred tubes.
Also, I don’t think there’s any evidence that uterine puncture on insertion is more common with women who haven’t had children. They “sound” your uterus first to make sure it’s big enough.
Finally, checking out the Mirena website for other countries is pretty interesting… IIRC, the U.S. seems to be the only country making it sound totally inappropriate for women who have never had children.
Also, I don’t think there’s any evidence that uterine puncture on insertion is more common with women who haven’t had children. They “sound” your uterus first to make sure it’s big enough.
Well, except for the doctors who won’t even do that if you haven’t had kids.
Two words for people who have no idea why doctors are wary of IUDs: Dalkon Shield.
And when you add in the whole Norplant fiasco, doctors are going to be very, very, super-extra-cautious about all of this stuff, because they’re already having trouble paying their malpractice premiums.
There is a small risk of PID at the time of IUD insertion, which can be mitigated by checking to see that you don’t have active chlamydia or other infections at the time, and by (optional) antibiotic prophylaxis at insertion. After 20 days, the risk of PID drops back to baseline.
The string on newer IUDs is a monofilament that doesn’t act as a wick in the same way that older braided strings could.
And, of course, the risk of PID needs to be weighed against the multitude of health risks associated with unwanted pregnancy.
“Two words for people who have no idea why doctors are wary of IUDs: Dalkon Shield.”
I wonder if they’re so much more skittish of things like IUDs than of things like Vioxx because dead people have a pretty hard time filing suit.
I wonder if they’re so much more skittish of things like IUDs than of things like Vioxx because dead people have a pretty hard time filing suit.
It’s not just that dead people have a hard time filing suit — it’s because dead people get a flat fee. People who are injured by a medication or a medical device need healthcare for many years to come, so it’s an ever-increasing expense that keeps showing up on your balance sheet every single year. Dead person is dead. The family gets a one-time settlement and the company doesn’t have to worry about any further expenses from that person.
It’s the same calculation that Ford made when they discovered that the Pinto had a tendency to explode when hit from behind — cheaper to pay out the settlements to the families of the people who died than to make a small change to the gas tank of every Pinto produced.
And libertarians wonder why I don’t trust corporations to solve everything ….
It’s not just that dead people have a hard time filing suit — it’s because dead people get a flat fee. People who are injured by a medication or a medical device need healthcare for many years to come, so it’s an ever-increasing expense that keeps showing up on your balance sheet every single year. Dead person is dead. The family gets a one-time settlement and the company doesn’t have to worry about any further expenses from that person.
Ayup. Dead people’s families can certainly file suit on behalf of the deceased (and on their own behalf), but not only does being dead cut off future payments, it does not result in a sympathetic injured person sitting in the courtroom.
Lady Grey, that’s the information I wish the doctor had given me. Instead she made it sound like I could just get an infection at random. If I had a better sense of what would make me higher or lower risk, I would have realized that my actual risk was just extremely low and insisted on getting the IUD. The damn thing would only have cost me $10 with my school insurance.
Interesting to know that Mirena’s website is different for other countries–I did find it discouraging that all of their materials here assumed that only women who had children would ever get it.