Sterilization as a woman: maximum security

A young woman knows that she doesn’t want to have children. That’s why she decides to have herself sterilized. But it’s not that easy.

Anne Ullrich cycled the short distance to the meeting point. She lives in Maxvorstadt, a bustling university district in Munich. With visitors, the 38-year-old likes to walk around the disused northern cemetery, which is used as a park. It is pleasantly quiet under the large, old beech and maple trees. Anne Ullrich is not her real name, she would rather not see it in an article. Because her mother and other family members know nothing about her decision.

Decide about yourself – in every respect

Anne Ullrich is used to making decisions. As a manager for 150 employees in a medium-sized company, the mechanical engineer has to be that. Immediately after the meeting, she will drive 300 kilometers to the small Franconian town where her employer is based. She has arranged to meet there for dinner in the evening. On Thursday she goes back to Munich to the apartment she shares with her boyfriend Simon.

The K question is “very socially charged,” says Anne Ullrich. For a long time she found it difficult to separate the expectations of others from her own wishes. “You get the message that every woman wants to have children“, says Anne. That’s why she waits until she makes a final decision. She feels that nothing is moving in her when her first friends become mothers. Simon met her when they were both around 30. Already with them On their first date, they openly talk about the fact that none of them have children in their life plans. Because his previous girlfriend really wanted them, Simon broke up with her.

When she reads an article for the first time about a woman who is being sterilized, Anne quickly has the feeling that this path would “totally suit her” too. Until then, she had been on the pill for 20 years and still lived in constant fear of the “worst case scenario,” as she calls it. “I don’t know how many pregnancy tests I’ve taken in my life,” says Anne. She starts looking for a practice that will carry out the operation.

A path full of hurdles

But it’s not that easy. Many gynecologists do not even offer the procedure. Others reject the sterilization of childless women or only operate on them after they are 30 or 35 years old. In forums on Facebook and other social media, women write dozens of times that they received no or bad advice about their concerns. Doctors who perform sterilization report patients who were previously turned away from five to ten practices.

“It’s absolutely not a niche phenomenon that women are told: You won’t find anyone at your age who does that,” says Susanne Rau from Leipzig. The self-employed translator had herself sterilized at the age of 28. But she continued reading the forums. It made her angry about the experiences other women had. Mid-20s who are turned away because they are too young. Women who were told that sterilizations are not allowed in Germany under the age of 35 – which is wrong. Susanne Rau then founded the association “Self-determined sterile” and created a website with a map of Germany. All gynecologists who carry out the procedure are listed there with a red dot.

If you click on one of them, a name and the address of a practice appear. An additional tab informs you whether there are any conditions, such as an age limit. Individual points are not assigned to a specific address and are labeled “Anonymous entry”. They are doctors who offer the operation but do not want it to be read publicly. The association will pass on your contact details upon request.

Searched, found

When googling in spring 2021, Anne Ullrich landed on the “Self-determined sterile” page. Although Munich has almost one and a half million inhabitants: not a single red dot. She only finds an entry in neighboring Dachau. Anne quickly gets the appointment for the preliminary interview. Simon accompanies her on the day of the operation. Hadn’t they also thought about the male version of sterilization, the vasectomy? Not seriously, says Anne. Not because Simon didn’t want it, but because she finally wanted maximum security for herself. She and Simon have an open relationship; in addition to their relationship, they allow each other to date others and have sex: “Our open relationship constellation certainly plays a role in my decision.” You are never safe from contraceptive failures, especially when having sex with a condom.

Shortly before the operation she caught a “Panic moment“, says Anne: “Are you really sure that you don’t want what most people want?”, “Didn’t you miss anything?” But she quickly becomes sure that she’s taking the right path. Afterwards, only a small one remains Cut back in the belly button. “I didn’t actually have any pain afterwards.”

More self-determination for women

In principle, sterilization is no different from knee surgery, says gynecologist Martin Teichmann: “Age limits of 30 or 35 are completely arbitrary. The only legal restriction is coming of age.” The 40-year-old runs a practice with his wife in a small town in Lower Franconia. Wednesday is her surgery day. Since they have been on the “Self-determined Sterile” menu, patients have come from all over Germany. Some had to travel over 500 kilometers, some from England, Switzerland, one woman even from Moscow.

The fact that they also offer sterilizations in addition to endometriosis or tumor treatments was never up for debate. “We don’t see ourselves as a moral authority,” says Martin Teichmann. “You can have a Brazilian butt injection, i.e. have your bottom enlarged surgically, although that is extremely dangerous. But shouldn’t women decide for themselves whether they want to be sterilized?“That is absurd. He doesn’t want to force anyone to operate themselves. “But what must urgently stop is that women are devalued, not given professional advice or given misinformation.”

But why this radical step when there are increasingly better long-term contraceptives such as IUDs, copper chains or rod implants? “There are cases where none of the contraceptives are suitable,” says Martin Teichmann. Because they can all have side effects – and a residual risk anyway. He even sees patients who are pregnant despite the IUD, which is considered very safe, in his practice several times a year. “We see women who don’t have sexual intercourse because they are so afraid of an unwanted pregnancy.”

Once you decide, you regret it for the rest of your life?

Not all women are permanently happy with their decision to have themselves sterilized. The last scientific surveys on this, to which the German professional association also refers, come from 1999; it was a US study with 11,000 participants. Accordingly, 20 percent of those surveyed who were under 30 years old when sterilized regretted the step. In the group of people over 30 it was only six percent. However, this does not take into account the fact that there are also women with children. The proportion of respondents without children who regretted sterilization was also six percent overall.

Martin Teichmann and his wife sterilize around 50 women a year. “I haven’t heard from anyone yet that they regretted the decision”says the doctor. Complaints come from other sources: gynecologists whose patients they had operated on called their practice several times. To tell them why it was wrong to operate on the women. That they were too young and that the desire to have children could have come later. And anyway, as their actual doctors, they should have been informed about the procedure beforehand. Martin Teichmann says that he is not allowed to inform other doctors without the consent of a patient.

A quick sideways glance at the men

Is vasectomy, i.e. male sterilization, treated similarly morally and emotionally? No, says Martin Teichmann. He knows many urologists from his environment or from specialist conferences. But he doesn’t know of anyone who doesn’t treat men under 30. “Of course, the vasectomy is the less complicated procedure and is easier to reverse.” But Teichmann does not believe that this is the reason why men and women treat each other differently. Rather, it is an expression of the fact that women are also treated unequally in the healthcare system, that they are not given the same self-determination over their own bodies.

“It’s really liberating to know that the issue is closed,” says Anne Ullrich this Sunday, three years after the sterilization. She finds it strange that this decision is made more difficult for women. “Afterwards I often asked myself why I didn’t do it sooner.”

Sterilization worldwide: The numbers

Globally, female sterilization is the most common method of contraception. This is shown, among other things, by a meta-analysis from 2022. While around eight percent of women in Germany are sterilized, in India it is one in three. The procedure is supported by the state there. Other contraceptive methods are often not freely available. The rate is also high in China and the Caribbean, but it is low in countries south of the Sahara, in Eastern Europe and Central Asia. There are also differences in industrialized nations: significantly more women are sterilized in North America than in Western Europe. Sterilization was often a means of oppression – and in some cases still are today. Example Canada: According to the local Standing Committee for Human Rights, forced sterilizations of the indigenous population are not yet a thing of the past there, despite the ban.

Bridget

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