Medical Notes: Let women be sterilised if they want to be

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YOU WOULD not be unusual if you count yourself amongst the many people who think it strange to visit the doctor unless you are ill. The role of doctor, and particularly of the GP, is based on the traditional and reasonable assumption that patients are unwell in some way and expect to be made better.

But what if a healthy, fit, and child-free - but presumably fertile - young woman wants to discuss contraceptive methods, then decides that sterilisation best matches her determination to remain without children and continue her child-free life style? Such a request, based on a personal assessment of her particular contraceptive needs rather than a medical diagnosis, challenges all expected and commonly adopted roles of doctor and patient. It's not surprising that some doctors are miffed!

Here are women who are otherwise well visiting their doctor to request not healing, nor medication, nor expert advice, but seeking access to an operation which is medically non-essential. In most cases the purpose of the visit is only to gain access to the next and most vital stage in the process, an interview with a consultant.

In the study that I carried out with 23 child-free by choice, electively sterilised women, many expressed high levels of anger against their GP who, in some instances, refused to make the initial referral to a consultant. The women had memories of "being laughed out of the surgery", "not being taken seriously", and "being treated like a child"; experiences which left them feeling helpless in the face of such dismissive authority. Even those who were persistent described sometimes harrowing and occasionally insulting interviews with consultants who not only would not consider sterilising child-free women but also rejected the possibility that any woman could make such a choice.

The medical profession does not encourage challenges and disagreements and so most child-free women seeking sterilisation experience the power of final refusal at consultant level. They have to apply elsewhere, usually by paying privately for consultations and, ultimately, the operation.

Doctors have a wealth of expertise based on experience and practice and considerable professional authority vested in their status and the role of medical practitioner. They do, however, also have a responsibility to ensure that they reflect on the needs of individual patients and to guard against lapsing into traditional and unhelpful ways of assessing women's requests and needs.

A common understanding and ideology - often, regrettably, based on outdated Freudian pronouncements about the "nature" of women - is that all women both want and need children and that a woman isn't fulfilled until she is a mother. The medical profession, unsurprisingly, is steeped in such beliefs.

There are no figures available which support the most commonly used reason for refusal, that child-free women will regret not having children, will change their minds after sterilisation and request reversal. A glance at the medical statistics which are available confirms that it is indeed the case that many women who have been sterilised do have regrets. Yet overwhelmingly these are women with children who used sterilisation as their final contraception and even within the medical literature itself there is evidence that child-free women who apply for sterilisation are extremely unlikely to have regrets.

Most women want children. Most women will have children. A minority of women don't and won't. As the world celebrates its six-billionth birth, the medical profession should not prevent women from exploring alternatives to traditional contraceptive measures and, if a minority choose to do so, acting upon positive decisions about their chosen and preferred life style.

Annily Campbell is the author of `Childfree and Sterilized: women's decisions and medical responses' (Cassell, pounds 14.99)