Family Planning Reproductive Health Sterilization

The Other Side of Reproductive Coercion

The image above provides information about the article cited below.

            Reproductive health abuses, especially coercion, have turned many people away from concern about human population. I agree: reproductive coercion should be shunned.

            Examples of coercive actions include sterilization of both women and men in India—even though patients didn’t really know what was being done. Coerced sterilizations also happened in the early 20th century in the USA—especially people who were who weren’t of the dominant race or were thought to be mentally or genetically deficient.

            There were attempts to wipe out Native Americans, which started when Columbus “discovered” the New World, and may have continued into the 20th century. This apparently happened at Indian Health Service hospitals, where a high proportion of Native women had their tubes tied. Fortunately, federal laws now require use of a special consent form that makes it difficult to perform sterilization procedure without real informed consent.

I have also read about Puerto Rican women being sterilized against their will in the past. When I practiced there in the 1980s, I saw no sign of coercive sterilization. In fact, the reverse was true. I remember Maria, who was desperate to stop having children. She couldn’t afford reliable birth control such as an IUD and pleaded with me to tie her tubes. Unfortunately, she didn’t have insurance and the hospital wouldn’t let me do the surgery unless they could be certain of payment.

 That brings up the other side of reproductive coercion—women are often forced to bear, and raise, children that they did not intend to have.

Obamacare and many other programs will pay for contraception in the US. However, most governmental programs will not pay for an abortion when a contraceptive method fails. Unfortunately, unintended pregnancies occur with all methods, and some states prohibit abortion under any circumstance, including rape.

 Since abortion has been tightly restricted or outlawed in many states, it has become impractical for countless women to obtain abortion care. Unfriendly laws have coerced many women to carry unintended pregnancies. Although networks exist to help women abort unwanted pregnancies, many people still aren’t able to make the choice they want.

A careful study of births in Texas found that abortion-limiting legislation increased unintended births. This research compared the number of births after Texas Senate Bill 8 (preventing abortions after 7 weeks of pregnancy) was in effect with the prior years’ births. They found that there were almost 10,000 more births in the relevant 9 months after SB8 took effect. Many of these excess births were probably unwanted because the women were coerced into carrying a pregnancy by their inability to access abortion care.

I predict that coercing women to bear and raise children will have bad effects on society. We know that people who result from unwanted pregnancies don’t do as well in life; they have more contact with mental health and with law enforcement agencies. We also know that Texas has one of the higher maternal mortality rates in our country, and forcing women to give birth is likely to cause the death rate to go even higher.I believe that the basis for antiabortion laws has little to do with the claimed religious beliefs; the states with the strongest “right to life” laws seem to have the weakest support of mothers and children after birth. I also believe that many people who advocate against abortion and for population growth do so for selfish economic reasons. Speaking of population growth, Nandita Bajaj, an expert on a cause of population growth—pronatalism—will be talking at Lifelong Learning in Durango on February 15th

© Richard Grossman MD, 2023

Family Planning Population Sterilization

Check out Vasectomy

Dr. Charles Ochieng at the International Conference on Family Planning

            Sixteen years ago the Durango Herald published my column “Do your Partner’s Vasectomy”; it got lots of laughs on April Fool’s Day! Unfortunately, the latest news on male sterilization is not so funny.

            There is some recent good news, fortunately. In some states, men are rushing to get permanently sterilized because of the recent Supreme Court decision about abortion. My experience, however, is that they will be moving a little more slowly after this minor procedure. I was sore for a couple days after my vasectomy, many years ago.

            Remember that vasectomy is much safer and easier than a tubal ligation, the female sterilization procedure. Male sterilization is done with local anesthesia and is finished in just 10 or 15 minutes. There are only two drawbacks to vasectomy. While female sterilization is effective immediately, it takes a couple of months after the procedure before a man starts shooting blanks. The other drawback is that many men are frightened to have it done.

            It is interesting to note the countries where vasectomy is most popular. The top five are: South Korea, Australia, Bhutan, the USA and New Zealand. Bhutan? Yes! Perhaps it is because that little country’s government has promoted this simple surgery. Bhutan has had mobile vasectomy camps which bring the service to villagers. Furthermore, men tend to take responsibility for family planning in this enlightened country.

            The bad news is that we seem to have reached “peak vasectomy”. Worldwide, the maximum number of couples who use vasectomy for protection from unintended pregnancy was reached in 2001. That year, 44 million couples worldwide were safeguarded by this simple procedure. The latest figures show a sad decline to just 17 million couples who are dependent on vasectomy.

            What can be done to bring back vasectomy? One group is doing its best to spread the good word all over the world. World Vasectomy Day,, has worked in several countries to introduce people—especially men—to this simple surgery. They claim: “World Vasectomy Day is the largest male focused family planning movement ever”. WVD was started by a New York film producer, Jonathan Stack, and urologist Doug Stein. Together, they have built an amazing crusade to not only to do the surgery, but also to train doctors to perform the procedure.

            Stein is a master of the No Scalpel Vasectomy technique. It uses a couple of special instruments that make it possible to perform this delicate procedure with tiny incisions. Because it involves less cutting, NSV has fewer complications than older methods.

            Vasectomy would be ideal for couples in developing countries who want to stop childbearing, since it doesn’t require a fancy facility. Dr. Charles Ochieng of Nairobi, Kenya    has become an evangelist for vasectomy. He had his own vasectomy years ago, and has done hundreds since then. An award-winning family practice doctor, he is devoted to providing vasectomies and teaching other physicians the NSV technique. He learned the NSV technique while spending time in Florida with Dr. Stein.

I met Ochieng at an international family planning convention in Kigali, Rwanda. He told me that he even offered to do his father’s vasectomy! His dad has 3 wives (polygamy is legal in Kenya) and many children. He was sad that his father turned down the gift. For some cultures, a large family is a status symbol, especially for men.

Now, as restrictions on women’s reproductive health increase in the USA, I hope more men will take this small, but important, step to prevent unintended pregnancies.

© Richard Grossman MD, 2023