Choosing to be child-free

When it comes to choosing a form of contraception that suits our needs, for most women it’s a case of trial and error.  Using the birth control pill can be tricky to remember to take at the same time every day, and gives some women intolerable side effects.  Condoms are easy enough to use, but are a bit fiddly in the throes of passion, and might give some women an allergic reaction or cause discomfort. The Depo-Provera shot is safe and convenient, but does cause some negative side effects like nausea or wonky menstrual cycles, and it needs to be repeated every three months. Hormonal intrauterine devices (IUDs) are long-lasting, effective birth control, which has the added benefit of reducing the flow of your period (score!). It does require an office procedure with your ObGyn, and it can cause some pain and cramping initially, and for several months following insertion. 

Tubal ligation is an effective form of contraception and it is considered permanent. A person could, however, get pregnant in the future with in vitro fertilization. Depending on the technique used and the age of the woman, the 10-year failure rate is under five per cent. Tubal ligation also may carry other benefits including reducing the risk of ovarian cancer, depending on the technique used.

For women and femmes who choose to remain child free, tubal ligation is a popular, permanent choice. Being granted access to the procedure, however, is a challenge with which many women under 30 struggle

For young patients, a gynecologist might recommend an IUD because there is a chance of regretting the decision in the future if something permanent like tubal ligation is chosen. Studies have estimated that the rate of regret for tubal ligation can be somewhere between four and 20 per cent, and is higher in women under the age of 30. 

But there’s an important distinction to be made here:  the rate of regret is higher among women who have already had children and wish to have more; the rate of regret of women among who have never wanted children is very low (six per cent). 

In a recent interview with CityNews, a leading gynecologist explained the disparity. “Women who want child-free living don’t change their minds,” says Dr. Dustin Cotescu, Family Planning Specialist at McMaster University. “People who have one or two children may decide later that they would like to have more. People might think that they’re causing harm in performing a tubal on a woman with no children; in fact those women are at lower risk of regret.” 

The push-back is so common that some child-free people have termed the experience of discussing their desire for tubal ligation and being faced with these dismissive phrases as being “bingo-ed”.  From the patronizing “you’re too young to make such a permanent decision,” to the delaying “you might change your mind,” to the downright paternalistic “what if you meet a man who wants kids,” all of these comments ignore the person’s gender identity, sexual identity, and most importantly, body autonomy and personal choice.

The reality remains, the choice should be up to the patient. Medicine, at its best, is meant to be shared decision making, and the decision for a tubal ligation is no exception. If you are convinced you desire a child-free life, it might be prudent to prepare yourself with research, answers to common health professional “bingo” statements, and firm up your resolve. It is your body, after all, and your choice. 

The official stance of the Society of Obstetricians and Gynecologists of Canada is that if you are fully informed on the risks, benefits, and alternatives, and you still choose a tubal ligation, then a doctor should offer this to you regardless of your age or if you’ve had children before. In practice, however, many women report being unable to access the surgery, largely through delays or redirections from their health care professionals. 

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