When Women Choose Not To: Overcoming the Hurdles of Voluntary Sterilization

As the Supreme Court debates whether to overturn the right to abortion, childfree women in the U.S. once again have to defend their deliberate choice not to have children.

Louise Vallee | Tuesday, February 15, 2022


Emily Oyler, who’s long known she does not want children, encountered pushback from a slew of doctors (Courtesy: Emily Oyler)

As Emily Oyler’s husband drove her to the hospital last fall, all she could hear was the sound of him chewing loudly on the beard beneath his lower lip. She sat next to him in silence for the whole of the twenty-minute-long ride, going over the speech in her head. When Geoffrey  dropped her off in front of the Capital Women’s Care building, in Fairfax (VA), she was still reciting it to herself.  

It had taken Oyler seven previous gynecologists, and it would take her another six flights of stairs to find her way to Dr. Nadim Hawa’s office. Tucking one leg beneath her to stop it from shaking, she struggled to catch her breath as a nurse took her blood pressure. She had put on almost 50 pounds since the last doctor inserted a hormonal implant into her arm. 

A few minutes later, Oyler had moved to yet another chair, across from her new doctor’s desk. It was plush, velvety and large, making her feel tiny, but she plunged into her big speech anyway. “I want a bilateral salpingectomy,” she said. Unlike others she had asked to take her Fallopian tubes out, Hawa didn’t laugh in her face or say that 25 was too young. He didn’t say she would change her mind or that she would make pretty babies. He also didn’t mention her husband’s potential desire for kids along the way. 

He just asked “Why?” which made Oyler defensive.

She continued with the speech she’d memorized over the weeks, not once looking at the printout she’d brought along just in case.

“I have known forever that I don’t want children,” she said. Then she recited all the facts: the multiple rejections she’d faced since she first began requesting the surgery at 18; her allergy to condoms; the side effects from every pill and implant she’d tried; her family history of endometriosis and ovarian cancer; the chronic vulvodynia that made inserting an IUD excruciatingly painful and therefore impossible; and the three-week long debilitating periods. All on top of the fact that she doesn’t and never will want kids, evidenced by a slew of character references from both her best friends and her husband. 

When she finally paused to take a breath, Oyler realized this was not what Dr. Hawa was asking. 

“I meant why don’t you want a full hysterectomy,” he said. Oyler started bawling. No one had ever said yes even to removing her tubes, so asking him to take her uterus out felt like a reach. Less than twenty minutes later, they scheduled the surgery. 

She called her husband in tears. He couldn’t get off work just yet, so she took an Uber home, ignoring the driver’s small talk while she messaged her friends in all caps and marked the date on her calendar. That afternoon, she had an eight-hour nap. 

Better access to contraceptives and years of feminist advocacy for better access to contraceptives have made motherhood more of a choice for American women. And since 2020, in the face of pandemic-induced trauma, economic concerns and climate disasters, an increasing number are choosing to forgo giving birth altogether. 

Some wanted to be childfree long before the past years’ chaos; never interested in “playing mom,” they certainly didn’t want to do it in real life. Others worried about what motherhood would do to their bodies, their lives, their careers. In the US, studies estimate that about 700 000 female sterilizations are performed every year. But when seeking a permanent solution, almost all encountered pushback from their doctors.

The hard-earned right to choose of women and people assigned female at birth (AFAB) is, once again, in jeopardy. While some Americans have embraced the slogan “My body, my choice” in opposition to the COVID-19 vaccine and mask mandates, the Supreme Court is currently debating this winter whether to overturn Roe v. Wade, the historic decision that legalized abortion in the United States. Tired of having their decisions repeatedly questioned, some childfree women are, in turn, focusing on more practical achievements, like access to voluntary sterilization. Once their tubes are removed or tied, there is no going back, which would mean they would no longer be at the mercy of political and societal whims. 

*****

Monica Trombley, 40, speaks with the precision of an attorney and the emotion of a trained actress. She has been both, but it has been fourteen years since she had to use her skills to defend her decision or play the motherly role many expect from women. 

“It’s been a weight off my shoulders,” she said. 

Trombley had just passed the bar when she got her tubes tied in 2007 – a procedure doctors have now largely replaced with salpingectomies, which have lower failure rates and offer better protection from ovarian cancers. “They trusted me to appear in court, but didn’t see me as responsible enough to be in charge of my own reproductive rights,” Trombley said of the objections she faced before finally finding one doctor who would listen in New York, where she lives now. 

At the time, she says, she didn’t have anyone to turn to for advice. Not only did the fierce red-head come from a conservative Christian household in North Carolina where her choice was frowned upon, but even like-minded women seemed to keep the details of their gynecologist appointments behind closed doors. 

Some “childfree” groups did exist. An online community like “No kidding!” — proud of its status as the “international social club for adults who have never had children” — has been around since 1984. There was also the private Facebook group “Childfree and loving it,” a space to vent about “those damn kids society loves,” which now has 11,000 members. 

But as the crux of the issue changed, so did the support groups. Today’s members are less likely to rant about children and more likely to discuss the practicalities of building their lives without them. On “Tie My Tubes, Yes Really,” another Facebook group, women share experiences on how they convinced doctors to perform their surgery. They even keep a “bingo” of the most common responses, along with useful comebacks: 

That widely cited study, which says over 20% of women regretted getting sterilized? It’s more than 20 years old and includes many women who agreed to the procedure while on anesthesia after a C-section. According to the same source, only 6% of non-mothers under 30 regretted their choice. 

“But you were a baby once?” “Yeah, and I’ll be a corpse someday, but I’m not letting them into my house either.”

The group also provides practical advice about the sterilization procedure itself, including the surgery prep and recovery process. 

But even with all these tools at her disposal, it still took Rachel Estis nine years to find a gynecologist willing to remove her tubes. After five rejections, the thirty-year-old financial advisor went into her appointment last summer “guns blazing.” She had alarms set on her phone every four hours that day – the minimum wait time between two Ativan pills, which help relieve her anxiety – but still threw up twice before 3pm. Like Oyler, she had a script, rebuttals ready for any line thrown at her, and all the documentation. 

She left the doctor’s office with a surgery scheduled for August 4, and remembers treating herself to candy and a new maroon sweater. “I feel like I’m prouder than I should be about getting sterilized,” she said, “but it’s just something I have wanted for so long.”   

*****

Nadim Hawa had been working as a gynecologist with Capital Women’s Care for almost seven years before he first met Emily Oyler. He says his profession carries a “heavy baggage” of preconceived notions, notably that women are destined to carry children. As a provider, though, he makes it a point to keep his opinions to himself. “It’s not my job to decide if you’re too young or if you might regret it,” he said. “My job is to make sure the procedure is safe, and to do no harm.” 

Oyler found Dr. Hawa on the “childfree-friendly doctor list,” a registry that women have been updating for years on a Reddit subchannel. It now has the names of hundreds of doctors, spanning the 50 states, who have performed sterilization surgeries in the past. Dr. Hawa’s entry promised “no bingo.” 

“I’ve never added myself to a list,” Dr. Hawa said. “I don’t like to get involved in all the social media.” While he doesn’t believe in physicians advocating or selling themselves online based on the surgeries they are willing to perform, he recognizes the role such groups have played for patients’ access to information. 

He says the number of women who get dismissed by their doctors is still “way too high.” 

Oyler finds irony in the preoccupation of some doctors that a patient might come to regret the surgery. “No one would ever tell a pregnant woman ‘Oh but what if you change your mind?’” she said. But women who don’t want to procreate are repeatedly seen as vulnerable to second thoughts. A 2018 study on denying women voluntary sterilization found it mostly boils down to expectations: many people still associate womanhood with motherhood and expect any deviation from that role to result in regret.  

At 17, Ari Mitchell knows a lot about not meeting expectations. Assigned female at birth, Mitchell is transgender and he’s hoping to go on with medical transitioning and get a hysterectomy. The teenager from Pennsylvania, who asked to do the interview over text, says his mother doesn’t want him to undergo any irreversible surgery. “She’s under the impression that one day I’ll grow out of it,” he wrote, “and I won’t.” But because of his mother’s fear, Mitchell has already had to go through an unwanted irreversible change – female puberty. “Isn’t that just a complete contradiction?” he asks.

*****

For Bailey,who asked CNS to withhold her last name because of the vitriol she’s experienced for being childfree, the most puzzling reaction is the one she gets from infertile women. Bailey, 26, works in healthcare and says that women who can’t have children often aggressively oppose her sterilization, arguing that it’s unfair that she would be able to make that decision when they couldn’t. “That sucks, I guess,” said Bailey, “but I didn’t realize I was gonna be their surrogate”. Weirdest of all, she said, is that these women are often willing to put themselves through extensive surgery to get pregnant. On the “flip side of fertility,” Bailey added, they get little pushback from the medical community. 

Until she got her salpingectomy, it took Bailey everything she had to stand by her decision. Her mother suggested she shouldn’t have the surgery, instead offering to help her get an abortion if she ever got pregnant. When she began to talk about her decision not to have kids as an undergraduate, the amount of “casual rape comments” she received from guys threatening to force a baby on her to change her mind prompted her to buy a taser. “I’ve always known it’s my body, my choice, but when people say vile things like that, it’s very hard,” she said. 

While Bailey hasn’t heard anything like that in about two years, both reactions left her unnerved. She didn’t share news of her surgery with many people in her life, and she is careful about revealing her childfree status online, where she says rape comments are still “sadly pretty common.” 

On October 27 2020, Bailey underwent her bilateral salpingectomy. That same morning, Amy Coney Barrett stood in the East Conference room of the Supreme Court, right hand raised and left hand on a family Bible, as she took the Judicial Oath as the 115th Justice. Groups opposing abortion had championed her nomination, and Bailey had read that Barrett’s was likely the final vote needed to overturn the Roe v Wade decision. When Bailey got home after her surgery, she stood in front of her bathroom mirror, and took a selfie of her bloated stomach, with her middle finger raised. 

President Donald J. Trump and Jesse Barrett look on as Supreme Court Associate Justice Clarence Thomas swears in Judge Amy Coney Barrett as Supreme Court Associate Justice Monday, Oct. 26, 2020, on the South Lawn of the White House. (Official White House Photo by Andrea Hanks)

“I like to think yeeting my tubes the same day Amy Coney Barrett got nominated is iconic AF,” she tweeted from her private account. 

Since then, Bailey has stopped trying to convince people who disapprove of her choice. “I mean, I’ve already done it,” she said. “What are they gonna do, stick my tubes back in there? Good luck!”

*****

Emily Oyler wasn’t done having to convince people when she got a call from a nurse on November 11. The hysterectomy was scheduled for the next morning. She had done all the work she could do ahead and deep cleaned the apartment.

“I’m very sorry, but the insurance just called, and they are denying the surgery,” the nurse said. The insurance provider had approved the surgery four separate times before, twice with Oyler, and twice with the hospital. Now they were saying that she was too young and that she’d have to pay nearly $20,000 out of pocket for the hysterectomy. The simpler salpingectomy, however, would be covered. 

Geoffrey rushed home when he heard the news and found his wife eating cookie dough between long sobs. She didn’t want to delay the sterilization and go through a battery of tests to prove to the insurance that a full hysterectomy was a medical necessity, only to risk another rejection. The couple decided on a bilateral salpingectomy instead. 

The next day, Geoffrey held his wife’s hand as they put the IV in her harm, knowing that she’s terrified of needles. Emily had told very few other people how scared she was about the surgery. “I’d been fighting for it so hard,” she said. “Now that I was finally getting it, I felt selfish and guilty to say ‘Hey, this is actually a major surgery, and I’m scared about this.’”  

She woke up three hours later, feeling fuzzy and “kind of drunk.” She remembers random disconnected details – asking the nurse when she could have sex with her husband again and if he had remembered the sugar cookies. It only really hit her the following day. 

She woke up three hours later, feeling fuzzy and “kind of drunk.” She remembers random disconnected details – asking the nurse when she could have sex with her husband again and if he had remembered the sugar cookies. It only really hit her the following day. 

“I am so happy this is done,” she said in a phone call 10 days after the surgery. As the pain medication wore off, she experienced increasing pain. She could barely get up or lie down for five days. Air was inserted in her body to inflate her abdomen during the surgery, and it rose to her shoulders. Any sudden movement made her feel like they had been dislocated. 

Still, she said, “it was worth it.” 

Twenty-five years after her own sterilization, Laura Smith, an aerospace technician from Western New York, agreed. As she was filing her income taxes one day, Smith realized she would never get to tick the “child tax credit” box. “That’s the closest I ever got to regret for not having kids,” she laughed. “It’s a good deduction.” 

Smith and her husband moved to Florida in 1996 and bought a house with a backyard in the sunny Tampa Bay area. When she got laid off a few years ago, she decided to take some time off to travel and try art classes. This lifestyle, she said, has led to some jealousy from people who couldn’t afford the nice things they have, because of their children. “Kids are definitely a financial burden, but it’s not like we’re taking food out of their mouths,” she said. “It was their decision to have them.” 

“You don’t have to fall for society’s lie that you need kids to feel complete,” Smith said. Still, she understands the crushing weight of expectations. At 54, she still hasn’t told her mother that she got her tubes tied back in 1996.  

About four days post-op, Oyler looked in the mirror and was hit with “overwhelming, gut-wrenching grief.” While she had 100 good reasons to give anyone asking why she doesn’t want to raise children, she always kept one to herself: she has done it before. 

For much of her childhood, Oyler raised her younger sister. When their mother locked herself in her room for days, Emily would go buy groceries, make dinner, and take care of the house. “I had enough energy and nurturing in my body to raise one person, and I used it on my mom and sister,” she says. “I feel physically incapable of it now. I’ve already been through it all, [and] I don’t want to do it again.” 

She sat on the floor and cried until her throat burned. “And then I got up, and that was that,” she said. Oyler stressed that these were not tears of regret. She was just processing emotions she had refused to allow in until she was sterilized. “I just feel so much better,” she said. “Knowing I never have to worry about kids, it feels like I’m a different, lighter person.”


This story is the work of a student at the Columbia University Graduate School of Journalism. Other news organizations are welcome to publish this story as long as they adhere to these guidelines.