|By Julie Deardorff, Chicago Tribune|
|McClatchy-Tribune Information Services|
For more than a year, Witt tried to get sterilized. Finally she went with her 28-year-old husband to a military medical clinic overseas, where Witt said he was given a vasectomy with few questions asked.
Decades after sterilization became broadly available to women in the U.S., some still have trouble obtaining one of the safest and most effective forms of birth control.
In interviews and on Internet forums, women report facing resistance and flat-out refusal from health care providers as they seek permanent contraception. Along the way, they encounter sexist and paternalistic attitudes, such as the assumption that all women desire children or that they'll come to regret their decision.
"I've yet to come across a story of a woman without children who was granted sterilization on her first request," said
"When I met with my first OB-GYN, he seemed to struggle with the idea," Palm said. "He was uncomfortable with sterilizing someone so young ... but I refused to back down. He agreed with the point that it was my body."
In addition to the fear of regret, doctors who are reluctant to sterilize a young woman may have misgivings because of their own religious beliefs, concerns about insurance coverage or potential liability, and the fact that other effective forms of long-term birth control exist.
"I strongly discourage it under age 30 because I've seen so many people change their minds," said Dr.
About 13 percent of women who obtain a tubal ligation express regret within 14 years, according to the U.S. Collaborative Review of Sterilization, though the CREST study found rates to be higher among younger, poorer and less-educated women.
But for many women, the potential cost of an unplanned pregnancy -- an unwanted child or an abortion -- or side effects from other forms of birth control are risks that far outweigh the potential for regret.
"Regret is the competent woman's burden, not the doctor's," said Richie, an adjunct professor at the
Physicians may fear doing something the patient might later view as detrimental, said
But Watson said the physician's focus should be ensuring that the patient receives adequate counseling beforehand. Informed consent also protects doctors from lawsuits, she said.
"Patients get to make the decisions because they are the ones who have to live with them," she said.
Doctors are significantly more likely to discourage a patient from undergoing surgical sterilization if she is younger, has fewer children and is not in full agreement with her husband, according to a national survey of women's physicians in the U.S. that was published in 2011 in the journal Human Reproduction. Nevertheless, nearly all the physicians said they would help the patient obtain the procedure if she persisted.