It’s 2018 – why is female sterilization still performed more than vasectomy?

 

Sterilization [either male or female] is the most widely used birth control in the US [36%], followed closely by female hormone treatments such as the pill [30.6%].

But permanent birth control – sterilization – is vastly different for men and women in terms of cost, risk, and recovery for the patient.

According to come quick research via the Mayo clinic website, the risks of female sterilization [tubal ligation] include: Damage to the bowel, bladder or major blood vessels, reaction to anesthesia, improper wound healing or infection and continued pelvic or abdominal pain.

According to the same website, the risks of vasectomy are very low, and none are potentially life-threatening, unlike damage to the bowel or reaction to anesthesia.

So why is female sterilization [tubal ligation] still performed in the US two thirds more than male sterilization [vasectomy]?

Our family has benefited so much from Haakon’s 2015 vasectomy that I wanted to tell our story as a way to look at some of the reasons vasectomy may not be as popular as it should be.

I can’t remember how the idea that Haakon would have a vasectomy after our second child was born came up, but I know it seemed like a natural progression to me:  I’ve had two babies and lots of genital involvement around birthing [not to mention years of periods and pap tests before the babies, and after], and a vasectomy was an opportunity for something medical to happen in his body.

Although I was mildly concerned about Haakon’s vasectomy – I don’t like the idea of someone cutting into anyone’s junk any more than most people, and there is the risk of permanent complications with vasectomy – I never considered that I would, instead, have tubal ligation.

From Haak’s perspective, as a man who is pragmatic to a fault, his initial research about vasectomy made it clear that to suggest I would have the surgery instead of him would be “foolish,” he told me.

But here in Montana, I hear this all the time from women: “I was in there anyway [hospital, to have a baby] so I told them, just go on and tie my tubes. I wish Tom/Mike etc would get a vasectomy, but he would never do it.”

[About half of female sterilizations occur within 8 hours of giving birth, according to the national center for biotechnology information]

My assessment of how often female sterilization is performed over vasectomy is backed by figures provided by the national center for biotechnology information in 2008. According to their website, 27 per cent of sexually active women in the US rely on female sterilization as birth control, while 9.2 per cent rely on vasectomy.

Although the information I found online is dated, all the US-based reports I found drew from the same study, which also notes that “Overall, the sterilization rates for men and women have remained constant over the past 40 years [since 2008].”

Why is this, I wondered?

The fact that the numbers of female sterilizations are higher than male is probably influenced by the number of babies born via cesarean section – the US center of disease control and prevention website says that in 2017, 31% of all births were cesareans.

When a woman is already having major abdominal surgery and wants a permanent form of birth control, having a tubal ligation performed at the same time makes some sense.

But where sterilization is sought in stand-alone cases, vasectomy is not only faster and cheaper [“best $300 we ever spent,” says Haakon!] than tubal ligation, it is much safer for the person being operated on.

One of Haak’s co worker’s, Shannon, recently had tubal ligation surgery. I spoke to her on the phone 11 days after her surgery, and she was still using a back brace to protect her bruised stomach muscles.

She had also developed anemia and a blood clot near the surgery area which is not life-threatening but is hard and painful.

“I’m still in pain,” Shannon said, “I keep asking the doctor if this is a normal recovery because they told me I would only have to take it easy for a week afterwards.”

Shannon and her husband had been talking about permanent birth control for years, she said, and he had wanted to have a vasectomy but a history of hernia surgery made them both concerned about how suitable vasectomy would be in his case.

“Now that he’s seen me go through this,” Shannon told me, “he wishes he’d gone ahead with the vasectomy.”

Although Shannon and her husband were well informed and made the best choice for them, its clear that in most cases, tubal ligation carries higher risks than vasectomy.

Despite this fact, I do not want to minimize the risk of chronic pain or long-term implications for a person’s sex life, which is associated with vasectomy in rare cases.

Shannon’s youngest child is now 10, and despite her long and continuing recovery from the surgery, Shannon told me her only regret is that she didn’t do it sooner.

Having access to permanent, relatively safe birth control is indeed a treat – after muddling through ten years of using various temporary contraceptives, like condoms and the pill, Haak and I were both 100% ready to say goodbye to the possibility of pregnancy scares and all the organization required to avoid them.

And so it came to be that one sunny winter’s day in Moruya, NSW, I was waiting at a coffee shop across the street from the doctor’s office where Haak was having his vasectomy done. Callie was almost six months old, and I ordered and sat in the courtyard breastfeeding her.

My parents happened to be passing through, and they arrived at that moment.

“Should I order Haakon coffee?” Dad asked.

I paused to answer, and looked up from my half-finished flat white:

And saw Haakon, bounding down the steps of the doctor’s office. A similar image to my very first memory of him, when he was tanned and 20, and bouncing across a lawn to meet me.

“Couldn’t they do it?” I asked sympathetically, imagining that the doctor was called away or held up in some way.

“It’s done,” he answered, beaming.

And that, my friends, is the kind of after-effect of a life-changing surgery you will almost never get. Haak wasn’t even in the chair for 15 minutes and was enjoying a coffee in the sun 5 minutes later.

He still likes to tell people that the worst part about having a vasectomy was shaving his testicles in preparation for the surgery.

“The chafing from the stubble growing back was intense,” he told me this morning when I asked what he remembered most.

Haakon was “sore for a couple of days,” he recalled. He took no painkillers and was back at work three days later.

Although it’s hard for me to say if Shannon and Haakon’s recoveries are typical of the surgeries they had, it’s clear to me that something deeper than a pragmatic weighing up of the costs and benefits is in effect when heterosexual couples begin to research sterilization – something that culminates in many making the decision for the woman to undergo surgery rather than the man.

Hearing versions of the “I wish Carlos would get a vasectomy, but he would never do it,” conversation over the years has made me realize how our society ensures that the only genital sensations men have are pleasurable – and that women support this idea as much as men do.

It’s certainly been said before, but I’ll say it again – we seem to be stuck, as a society, in a pattern of accepting at face value a woman’s responsibility for all things reproductive, from unintended pregnancies and childcare to buying the condoms.

But it’s 2018 and vasectomy just might be the way forward – a way to revolutionize our relationships and sex lives.

Haak

 

I found information for this post from these sources:

CDC website, stats about cesarean rates: https://www.cdc.gov/nchs/fastats/delivery.htm

NCBI website, articles about rates of sterilization: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492586/

Mayo Clinic, basic info about vasectomy and tubal ligation: https://www.mayoclinic.org/tests-procedures/vasectomy/about/pac-20384580

 

Thanks for reading!

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Contraceptives: the real measure of inequality

Aside from having my basic human needs met, what is the greatest freedom I have?

Since 2011, when I had my first child, my first thought when I see my belly is always gratitude.

Belly crop

I’m grateful that I was able to grow two healthy babies. I’m humbled that I got to choose when I conceived [roughly!] and with whom.

I’m so, so grateful to my mum for being into homebirth so I knew that was a possibility, and so honored that Anki was our midwife, and both kids born into water at home.

And I’m delighted that I have chosen to close that chapter, and that Haakon has a vasectomy, leaving us completely free and easy with regards to contraception [I’ll talk about the merits of vasectomy in a later blog].

No more wondering when a period is later than usual if a baby is the reason.

No more hypothetical moral grappling – if I were pregnant, would I abort?

I see this access and the ability to control when, and if, to have kids, as the ultimate luxury, and one humans have not been enjoying for very long.

I don’t care how many babies people have, when they have them, or if they don’t, or if they have them with many different partners, or a same sex partner, or raise them alone.

But now that we have such amazing options for contraception, I care very much about people only having babies that they want.

According to the US census website, the world population is 7.6 billion as of May 2018, and growing by about 180,000 per day.

And the United Nations Word Population fund says that 214 million women in the developing world who want to prevent pregnancy don’t have access to contraceptives.

We should want to fix that, because parenting is not for the faint of heart – a friend’s toddler once threw her head back and broke her mother’s nose during a tantrum. Most of us parents have cleaned a log of poop out of a pair of pants at least once.

Having and raising a child takes resources – food, clothing, money or bartering power. But it also requires support, a community, social capital.

If you have no resources, especially social resources, having a baby will not magically make them appear. And we need those resources – every one of us has felt squeezed dry at some point by the emotional demands of parenting.

Knowing this, sexually active women everywhere spend hours, weeks and months of their lives caught up with trying not to get pregnant.

More and more men are taking responsibility for not making babies, but since the evidence is written on a woman’s body she is often the most invested in preventing pregnancy.

In both of my homes, the US and Australia, people generally have pretty good access to contraceptives, whether drugstore condoms or an IUD, implant or vasectomy.

But access doesn’t necessarily trump culture. Although contraceptives are technically available in white, rural America, where I live, they often remain just out of reach of those who really need them – young people.

A conservation, religious undertone means sex ed leans towards teaching abstinence.

I just got back from a walk to the park, where I bumped into Tyran, who is not quite 21 and has two sons – a  four year old and an eighteen month old.

I asked her about her first pregnancy, and how that came about, how she felt about it.

“I was 14 when I got pregnant, and I had Lovell when I was 15,” Tyran said.

But Tyran wasn’t naive about getting pregnant:

“Oh, I knew how it [sex] worked, my mom told me, and we had sex ed at school,” she said “they didn’t give us condoms though, I think that would be good, if there was a clinic you could get free condoms, if they put them in our hands.”

Thinking back to being 14 myself, and remembering not being able to see past a week, I asked her if she just didn’t care.

“Yeah, I think that was it. In that moment I just didn’t care, I thought I loved him.”

Tyran, with help from her mom, the grandparents of her kids, and her youngest son’s dad, who pays some child support and has custody of both kids whenever he can, has fulfilled the American dream.

Work hard, fight adversity, not get an abortion.

Of her youngest child, Tyran said:

“His dad is really cool. A nice guy. We got married after 3 months because everyone said to me ‘why not, he loves Lovell,’ and I thought maybe god was giving me this, a family,”

She gestured to her youngest son, in his stroller, as we walked.

“But he [god] was really just giving me another kid,” she said, and smiled and stopped to adjust her son’s visor “he was conceived on a pull out couch. That’s kind of ironic, isn’t it?”

Tyran plainly loves her kids.. She sent me this picture of her sons, Lovell and Kale:

lovell and kale

Although Tyran was close to getting the contraceptives she needed, and turned a hard situation into a positive one, in some places, getting and using contraceptives effectively is an even bigger hurdle.

A family friend and doctor of sociology, Richard Barcham, told me a bit about the availability of contraceptives in Papua New Guinea, where he has worked on and off since 2000.

According to Richard, people in PNG are generally not shy about talking about sex and contraception, and tend towards being “pretty promiscuous.”

The biggest hurdle in getting contraception to those who want it, he said, is the power men have over women.

“The status of women is very low,” Richard wrote in an e mail “a large family is a big loyal workforce for a man to build prosperity, so men sometimes have multiple wives.”

Richard has heard women say they carry condoms in case of rape: he said rape is “gut-churningly and bizarrely common.”

Although the PNG government offers what it can by way of health services, most people have never seen a doctor, Richard wrote.

Churches and other aid groups provide better and more healthcare than local services, and because of religious conflicts, these groups often don’t offer contraceptives.

If a woman is offered long term contraceptive options, like an injection or implant of hormone birth control, often her husband must give permission, and “this can be a problem,” Richard said.

Richard told a story about working with a non profit group called Touching the Untouchables, who aim to bring health care to people in the highlands of PNG, only accessible by one road, which is “a bit dangerous,” because of road accidents and highway robbers.
“We often traveled in a District ‘ambulance’,” Richard said  “really a Toyota troop carrier and not anything like an ambulance at all. I recall on one occasion travelling in the front of such a vehicle,  with a health worker and the driver, while a group of village volunteers, NGO staff and their cargoes bounced around in the back. The health worker had boxes of stuff on her lap, and every time we passed a group of people standing by the road she would pass handfuls across to the driver. Behind us, people scrambled in our dust to pick up these tossed treats. On closer inspection, the contents of the boxes turned out to be condoms.”
A rising awareness in PNG of using condoms to prevent HIV, as well as to control pregnancy has made their use more popular. Richard sent me this link about a recent donation of 120,000 condoms to PNG.
The best part? every one of those condoms is strawberry scented!

 

If you appreciate your freedom with family planning, and want to gift that to another person, some organizations that provide contraceptive aid in the US and internationally are:

The United Nations Population Fund 

The Bill and Melinda Gates Foundation

Planned Parenthood

Pathfinder International