Nina MacNamara Author & Bi-Feminist-Killjoy. Occasionally has something interesting to say. The importance is debatable. Your mileage may vary. Books: "Icarus" and "A Bitter Spring"

How to Avoid Getting Pregnant in the United States, Part 1

In May, I asked my gynecologist if she would remove my fallopian tubes. 

I’ve been long aware that this world isn’t kind to women. While it’s a privilege to be in the US, where our reproductive rights are only being chipped away instead of chiseled away, I currently live in the South — choice here means Clemson or USC, UGA or LSU, Alabama or Auburn. Marriage is also a sacred bond between you and your husband, or the next husband, or the next husband, or the next husband. No one has babies out of wedlock and the number of virgin births outnumbers those within. And finally, if you’re married longer than two years and don’t produce as many offspring, well lawdawmighty somethin’s wrong! You’re probably broken inside and your husband’s disappointed and is probably making virgin births outside the house. 

I’ve known that I haven’t wanted children since I was 21 years old. If I’m honest, I haven’t wanted children since I was 14 and started menstruating. I could regale you with the details of why I don’t want children, but I feel like every childless person has some variation of the same speech:

  • I don’t want kids
  • It’s not that I hate kids
  • I love the children close to me (nieces/nephews/friends’ kids)
  • They’re just not for me
  • It’s ok that you have kids
  • But…why do you have kids?
  • Seriously, did you ever question if you actually wanted kids or did you just go along with what society wanted from you?
  • JK, take it easy, don’t be so insecure
  • No, I don’t consider my pets to be my children and I know the difference between the two.
  • Yes, I’m very happy with my life 
  • Nope, I’m not changing my mind 
  • Thanks for coming to my TEDTalk

See? Boring. I’m not here to change your mind about having children and I’m not interested in the same arguments for why I should have children. Let’s all go back to our corners and continue on with our lives.

I’m also well aware that on the onset of menarche, we women become walking timebombs: before the age of 40, someone has to make us pregnant, otherwise we’ll explode and become useless to the world. Ideally, this should be before age 35 — remember, 35 is the OMG YOU’RE DYING year according to doctors. Forty, I keep being told, is the end of our lives. We’re no longer fertile, firm, or fuckable. We’re brittle and delicate. Our bones degrade and skin flakes off. Forty is old. Forty is done. You had to put off college or career in your twenties and thirties? Well, tough shit! Once you reach forty, you’ve got to pack it all in, stay inside, and never see the light of day again because who wants to see forty-year-old women in public? Gross! Next thing you know, we’ll have to give them rights and equal pay!

I encountered the first of this age-related pressure over the last few years when I went to my doctor. A few years ago, I asked my gynecologist about a replacement IUD.

  • Her: The risks associated with hormonal birth control increase after age 35. That includes blood clots and stroke. 
  • Me: (Stunned). Um…wow. What other methods are there?
  • Her: You can get the copper IUD. 
  • Me: Ok.
  • Her: But you already have problems with painful, heavy cycles. You probably don’t want that.
  • Me: Ok… What else can I do?
  • Her: What about a tubal?
  • Me: As in, get my tubes tied?
  • Her: Sure. It’s a quick procedure. 
  • Me: Not sure I’m ready to be operated on just yet, but maybe in a year or two. 
  • Her: I guess another hormonal IUD. 
  • Me: Um, ok…

Except, it didn’t. It turned out, I have epilepsy and would have to have my IUD taken out just 2 years later after being unable to get my seizures under control with medication. My neurologist was happy with this decision, but I was not. See, I don’t just live in the South, I live in the great state of Georgia. The same time I was getting my IUD plucked from my body, HB 481 passed. One of the sponsors of the bill was my district’s representative. 

I was running out of time to decide what I wanted to do, but I already knew what I wanted. It was just a matter of when. 

I stumbled upon the phrase bilateral salpingectomy by accident. Oh Joy Sex Toy, a web comic, ran a guest comic (note: OJST is not safe for work but the comic I linked to is) about the procedure: a laparoscopic operation that removes, not binds, one’s fallopian tubes. The uterus and ovaries are left alone, meaning you still menstruate and ovulate as normal until menopause. Eggs released from the ovaries, without fallopian tubes, will just reabsorb into the body. Best of all, the procedure is outpatient — no overnight stays in the hospital and because it’s laparoscopy the recovery time is shorter.  

Intrigued, I did a little more reading into the benefits of a bisalp over a tubal. First, with a tubal, there is always a small chance of pregnancy — ectopic pregnancy — which can be life threatening. Second, recent research into the most aggressive types of ovarian cancers have shown them beginning not in the ovaries but in the fallopian tubes. Removing the tubes reduces the risk of ovarian cancer by up to 78%.

As the kids say: they had my curiosity, but now they had my attention. 

Getting my gynecologist to agree to the procedure was the next step in this process. 

Personal reproductive choices are more than just safe abortion access and hormonal birth control availability (though they encompass those stances, too). Sterilization is part of one’s reproductive rights, too. Whether someone has had zero children or seven children, safe access to any type of sterilization should be a health care right for everyone. Unfortunately, sterilization comes with a dark and ugly history, particularly around women of color:

I was 100% prepared for my doctor to waver with my request because of this history. To assuage her hesitancy, I thought about offering her a one-page, single-spaced essay about why I wanted this done. That sounded ridiculous — I wasn’t in college any more and she wasn’t grading me on my effort to move her with my words. She was a doctor. All I had to do was sign some consent forms and give her some money. 

But no, that still might not be enough. 

Reading through r/sterilization and other blog posts from women who’ve had bisalps before, I learned that a lot of doctors don’t want to sterilize consenting adult women1. Some doctors outwardly refuse unless the woman has already given birth, past a certain age, or in dire health. I’ve never been pregnant and my physical health is above average. Whether I’m “past a certain age” is up to a doctor to decide. I mean, I shouldn’t have a problem — after all, I’m 37 and near death, so removing my tubes won’t be an issue, right?

In May, I asked my gynecologist if she would remove my fallopian tubes. 

She frowned and said, “I don’t like this. I wish you would wait until you were 40.”

I blinked. Seriously

Look. Absolutely no hate toward my doctor. I understand a care provider’s hesitancy to provide a permanent change in a person’s body. There’s no going back from sterilization. It’s a big change. You have to know that you 100% don’t want to get pregnant naturally. This is not a decision one makes on a whim.  

But…I mean…c’mon. Forty? Really? I’m 37. I’ve had ample opportunity to get pregnant by now and it hasn’t happened because I did not want it to happen. I haven’t been waiting for the right time to have children. I haven’t been waiting for Mr or Ms Right. I’ve simply not been interested. What are three years going to do? 

And also, had the shoe been on the other foot and I had been dying to get pregnant, my doctor would have done anything for me right then. She would have given me hormone treatments in the form of creams, shots, and pills. She would have set me up with specialists. She would have given me the phone number to the nearest sperm bank. Hell, she may have stood over my shoulder while I downloaded Tinder for the first time and guided me through swiping right on whatever dick I could find — all in the name of getting me pregnant before the age of 40

And if I asked for another 5 years on hormonal birth control despite the increased risk of blood clots and seizures, she would have given that to me — before the age of 40.

But for some reason, asking for an operation where I didn’t have to worry about getting pregnant and the risks after the age of 40, necessitated pushback. 

I told her, “I don’t want to be in a situation where I’m either a single mother raising a child in my 40s or have to terminate an unwanted pregnancy.” 

She paused thoughtfully. Then she nodded. “Ok. We’ll set you up with a date as soon as we can.”

And so, that was done. I had an easier time than a lot of other women, but still encountered a speed bump. 

But then came the final hurdle in my quest for removing myself from the gene pool: paying for it. 

The Affordable Care Act is a great thing. Full stop. People who were unable to get health care coverage before now have it and have reaped the benefits from it. Thanks, Obama!

But it’s not perfect. In particular, birth control. Though there are guidelines under the Health Resources & Services Administration (HRSA) and 18 FDA-approved methods for women’s preventative services, it doesn’t cover all methods of birth control — including sterilization. Those guidelines just direct insurance plans to cover (at full cost) one method of birth control from each of those categories. For instance, number 5 on that list of methods is “intrauterine devices with progestin.” Your health insurance gets to pick what type of IUD that is. So if your insurance only covers Mirena, but you want Styla, you could be obligated to pay full price. IUDs, as you may know, are not cheap

Number 1 on that list is “sterilization surgery for women.” My insurance company only covers bilateral tubal ligations at full cost. Anything else, I have to pay up to my very high deductible. 

All of this is moot, however, if your insurance provider is through certain religious employers like churches or non-profits.

Birth control is free for women, except when it isn’t

I’m privileged to be in a position where I can pay my remaining deductible. However, you can bet your ass that I’m contacting my insurance company about why they haven’t also covered the bisalp as well as the tubal. Maybe bisalps aren’t popular enough. Maybe my insurance company hasn’t caught up with the science behind why doctors prefer them over tubals. Looking at this as an insurance company, I would rather cover a bisalp than ovarian cancer treatments — wouldn’t that make more financial sense?

(Actually, it would be better for everyone if we had a system of price regulation on our health system in this country and a better means of delivering affordable care to all people. But that’s a different rant.)

A week after my May appointment, I got a call from my gynecologist, wanting to confirm my surgery date. They scheduled me for July 2, which was over the 4th of July weekend. I’d have time to rest and recover.

I said, “July 2nd. I’ll be there.”

Now all I had to do was show up. 

To be continued.

1 I do recognize that not all women have female reproductive organs and my use of “woman” in this essay is only shorthand. Trans rights.

Nina MacNamara Author & Bi-Feminist-Killjoy. Occasionally has something interesting to say. The importance is debatable. Your mileage may vary. Books: "Icarus" and "A Bitter Spring"


Nina MacNamara
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