Hannah Anderson doesn’t want children.
The 27-year-old Coloradan wants to be able to hop on a plane when wanderlust calls. She wants a financial cushion free of child-related costs. She dreams of dedicating time and energy toward fostering animals.
Over the years, Anderson cycled through numerous birth control options — intrauterine devices and contraceptive injections — that caused her negative side effects and distress. A couple of years ago, when Anderson was sure she desired a child-free future, she told her doctor she wanted permanent birth control: sterilization.
Anderson’s doctor refused, saying someday she might have a husband who wants kids.
“It’s very demeaning,” Anderson said. “I felt like, ‘Are they allowed to say this? Am I being punked?’ If my future husband wants kids then that’s not the right person for me.”
Locally and nationally, reproductive health physicians say they are seeing more people inquiring about or seeking sterilization procedures as a permanent form of contraception since the U.S. Supreme Court’s reversal last month of Roe v. Wade, the landmark 1972 ruling that established the constitutional right to abortion.
The procedures aren’t uncommon. Among sexually active Coloradans between the ages of 18 and 44 who use contraceptives, 30.8% report using sterilization — female sterilization, hysterectomy or vasectomy — as a form of contraception, according to 2019 data from the Colorado Department of Public Health and Environment.
However, interviews with Coloradans who’ve considered taking that step show that people — particularly young women — can face pushback from doctors when seeking these medical procedures, so much so that a crowdsourced list of gynecologists from across the country who will perform sterilization procedures without judgment is circulating on the internet. The list, more than 1,250 physicians long, features 40 doctors across Colorado.
Ashley Allen, a women’s health doctor at Montrose Regional Health, added her name to the list after having a number of patients tell her that other doctors refused to perform sterilization procedures because of the patient’s age or relationship status. Allen wanted to make sure patients in rural Colorado knew they had this health care option available.
“We’ve had more patients come in wanting to discuss these options because of the political climate, and I’m happy to discuss it,” Allen said. “For a woman to be in control of their own body and make that decision, regardless of if they have a partner or if their partner wants to have children — you can’t say to a woman that she has to be pregnant because her husband wants to have kids. That’s not how it works. Forcing women to potentially become pregnant, particularly at a time when they are potentially losing their rights to an abortion in many states, I think is unfair.”
“A better life for me is one without children”
Sterilization procedures include tubal ligations — sometimes referred to as getting your tubes tied — along with salpingectomies, the removal of one or both fallopian tubes, and vasectomies.
While tubal ligation reversal does exist, it is not always possible and experts say the procedure should be considered a permanent birth control solution. Almost all vasectomies can be reversed.
In most cases, the procedures are outpatient surgeries, Allen said, and are considered low-risk. They don’t impact a patient’s hormone production.
“Historically, there has been some pushback from physicians mainly out of fear that women are going to have regrets about not being able to get pregnant in the future,” Allen said.
It’s inevitable that some women will regret the permanent birth control option, Allen said. However, she said her job is to educate patients inquiring about the procedures and make sure they understand the permanency of the decision. If they decide that’s the best option for them, she is fine moving forward.
Ana Gomez, 36, of Steamboat Springs eventually found a doctor in the UCHealth system who would perform her salpingectomy two years ago, but said she faced comments from her provider such as, “So your mom is never going to be a grandma?”
Gomez, whose parents grew up in Mexico, said children of immigrants are often reminded of the sacrifices their parents made for their children to have a better life.
Gomez is a homeowner with a fulfilling, time-consuming career as a state employee who relishes traveling with her partner and building their savings together. She plans on bearing the responsibility of caring for her aging parents.
If a desire to connect with a child arises, Gomez said there are mentorship or volunteer opportunities that would enable her to help a young person grow.
“They want you to have a better life than they had but they also need to understand that we get to decide what that life looks like for us, and a better life for me is one without children,” Gomez said. “This constant need to question somebody that has made a choice for themselves is a little ridiculous because people aren’t making these serious choices on a whim. There is a lot of thought into it.”
“Ridiculous, insulting and beyond exhausting”
For Zoe Schacht, sterilization isn’t as much about a child-free future as it is a pain-free life.
The 21-year-old has been diagnosed with endometriosis, a disorder in which tissue that normally lines the uterus grows outside the uterus where it shouldn’t. The disorder causes Schacht severe pain, months-long menstrual cycles that have left her anemic and spurred surgery to remove endometrial lesions that left her with lingering nerve pain.
Schacht has had miserable menstrual cycles since her early teen years and began inquiring about a hysterectomy — the surgical removal of the uterus — from the time she was 16. Doctors have told Schacht that she is too young to make a decision she might regret.
Unlike tubal ligations, a hysterectomy stops menstrual cycles and could instigate menopause and dramatic hormonal changes.
Schacht said she understands a hysterectomy is a big, permanent life decision.
As a queer woman who dates women and has a disorder that already complicates pregnancy, Schacht said if she wanted children down the line, she would already be looking into alternative options.
“It’s so frustrating that any health care provider would look past my pain struggles and be inconsiderate of that, but also to prioritize the possibility of me having a child over my own pain,” Schacht said. “In my reproductive life, I have probably 20 to 30 more years of this and the idea that any doctor would think the potential of me having a child in the future is more important than those 20 to 30 years of living not in pain is ridiculous, insulting and beyond exhausting.”
Schacht continues her search for a doctor who will remove her uterus, but hasn’t found one yet.
“Misogyny is real”
When 31-year-old David Ferree and his wife decided kids weren’t for them, the Loveland couple also decided Ferree would get a vasectomy. Ferree believes men should take a more active role in reproductive health.
Ferree was sterilized in 2019 and described the process as quick, easy and manageable.
“I walked in and waddled out in 30 minutes,” Ferree said.
Having heard horror stories of his female or queer friends seeking sterilization surgeries, Ferree was prepared for anything, but said he faced no pushback or complications.
“It was illuminating how my process was so completely different than what I’ve heard women and queer people go through,” Ferree said. “Nobody asked my wife’s permission. Nobody asked if I had really thought about it. Nobody tried to talk me out of it. I was able to make my own choice.”
Meanwhile, when Anderson finally found a private practice doctor to perform her sterilization procedure in 2018 after two years of searching, she sat in her car after the consultation and cried with the relief of talking to a medical professional who took her seriously.
Still, on the day of her surgery, as she was in her hospital gown awaiting the procedure, Anderson’s heart sank when a nurse turned to Anderson’s then-boyfriend and asked why he was allowing Anderson to have the procedure.
“The whole situation was such an emotional rollercoaster because you expect the best out of people, and I feel like I am usually treated like a human being, but in this situation, I was treated as less than,” Anderson said. “It’s eye-opening because you see so clearly that misogyny is real.”
“Shared decision-making model”
Jaime Arruda, a professor at the University of Colorado’s Department of Obstetrics and Gynecology who also practices surgical gynecology, said the way in which a physician responds to a patient inquiring about sterilization varies doctor by doctor and can depend on the hospital, the doctor’s own beliefs or what type of insurance a patient has.
Lower-income patients on Medicaid, for example, must wait 30 days before the surgery after a physician signs off on a form agreeing to the procedure, according to federal law. The 1978 policy started as a way to protect publicly insured women from forced sterilization at a time when women with Medicaid often were victims of reproductive coercion or compulsory sterilization, Arruda said.
“In practicality, sometimes what that form does is make women who want permanent sterilization wait or get lost to follow up or get pregnant during that time,” Arruda said. “Someone who has private health care can say they want a tubal ligation and get it scheduled tomorrow, but a woman who has lower income has to jump through hoops.”
Allen, the doctor at Montrose Regional Health, said she’s been in a situation where a woman on Medicaid comes in with an ectopic pregnancy — a potentially life-threatening situation when the fertilized egg implants outside the uterus — and wants to have a tubal ligation and have her fallopian tubes removed to prevent another risky pregnancy.
“She really should because of the risk, but because of the 30-day waiting period, the hospital wouldn’t be reimbursed for that procedure under that insurance,” Allen said.
Some doctors or hospitals, Arruda said, will refuse to do the procedure based on religious beliefs.
Catholic hospitals, for example, are prohibited from providing direct sterilization, according to Gregg Moss, spokesman for SCL Health, which operates Saint Joseph Hospital in Denver, Good Samaritan Medical Center in Lafayette and Lutheran Medical Center in Wheat Ridge.
“Procedures that induce sterility are permitted when their direct effect is the cure or alleviation of a present and serious pathology, and a simpler treatment is not available,” Moss said. “The Ethical Religious Directives are designed to enhance and protect the dignity of the human person and the sanctity of life.”
Representatives of Kaiser Permanente Colorado declined an interview request to discuss the provider’s policies on performing sterilizations, and instead released a statement.
“Decisions to proceed with sterilization or vasectomy — as with any surgery or procedure — come only after a thorough discussion between physician and patient during which all benefits and risks are weighed, and informed consent is granted and documented,” spokeswoman Elizabeth Whitehead wrote.
Other doctors, Arruda said, may discriminate against younger women because of a concern they will regret the decision later in life. Others might want to develop a relationship with the patient first and give it some time before agreeing to do the procedure.
“It’s kind of gone away from that paternalistic side of OB-GYN where we tell patients what to do and at least now we’ve gone more toward a shared decision-making model,” she said. “Nowadays, there are fewer surgeons who would outright refuse sterilization based on age. I think it’s my job to tell you what the risks are — one of those risks may be you will regret it or you might be spending $20,000 or $30,000 to do (in vitro fertilization) — but at the end of the day, it’s my job to tell you the risk and your job to decide if you want to take that risk.”
Subscribe to bi-weekly newsletter to get health news sent straight to your inbox.