Reproductive freedom is one of those hot-button issues. The Supreme Court's Dobbs vs. Jackson's Women's Health Organization ruling in June 2022 functionally overturned Roe vs. Wade and allowed abortion-banning trigger laws in 9 states (out of 13 states with legislation in place) to immediately take effect. Another 26 states are expected to enact some kind of abortion-restricting legislation in the near future.
The recent Dobbs ruling doesn't just impact elective abortions. It's impacts include reduced access to reproductive health services, abortion pills, medically necessary abortions for things like ectopic pregnancies, and body autonomy on the whole. The ruling is forcing doctors to make impossible decisions about women's lives. Almost immediately after the Dobbs opinion was announced, stories about medical providers being forced to decide if a medically-necessary abortion was justified to save a patient's life started emerging, with hospitals stuck in a legal limbo where they felt they couldn't provide life-saving abortions without putting the hospital at risk.
At the end of the day, in many states a corpse has more right to body autonomy than a women. And don't get me started on the lack of support during and after pregnancy for low-income families.
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Why am I so worked up about reproductive rights? If we're being honest, I'm always worked up about them. Reproductive freedom includes more than just abortion access - it's access to contraceptives, regular screenings, fertility treatments, prenatal care, and family planning. Every woman who has had to had to terminate a non-viable pregnancy knows that reproductive freedom extends beyond the over-simplified (and incredibly judgmental) "should have practiced safe sex and you wouldn't be in this situation" portrayal of anti-abortion groups. By restricting access to screenings and contraceptives, you increase the odds of people needing abortions. You force people into untenable situations. You ruin lives.
I know women who have had abortions. Be it failed birth control (nothing is 100%, even when used properly) or a much-wanted but non-viable pregnancy, they're just another case study in doing everything right and still being forced into a hard situation. Into a situation where you have to have an abortion procedure to save your life due to an ectopic pregnancy. Into a situation where the choice is to carry an unwanted pregnancy to term in a body so young that it's not developed enough to handle the stresses or face hateful rhetoric from strangers standing outside Planned Parenthood.
It has always frustrated me that responsibility for family planning and contraceptives largely falls on the people with a uterus. A guy wants a vasectomy and generally gets zero pushback or questions beyond "do you have kids and do you want them?". The procedure is fast and relatively noninvasive. But a woman asks to be sterilized and is subjected to a litany of questions and pressure, with the choices she is trying to make about her body and future second-guessed at every turn. Oh, you're of a child-bearing age and we don't want to sterilize you. You don't have kids yet and this is irreversible - you might change your mind because we know what you want better than you do. If you're able to convince a doctor to sterilize you, even at its most noninvasive you still wind up with incisions through your abdominal wall which take time to heal and pose an infection risk. And that's for tying your tubes. If you opt for a hysterectomy you're looking at 3 abdominal incisions plus a vaginal incision. While it's an outpatient procedure (unless they do an abdominal hysterectomy where they cut you open a la C-section), it's a lot of holes through muscles that need to heal and a significantly more intrusive procedure than a vasectomy.
But sure, other people know what I want more than I do. I'm going to change my mind because all women want to have babies.
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Having never wanted kids and as someone who has some pretty awful menstrual cramps, I've considered sterilization for years. I brought it up to one of my providers when I was in my mid-20's and they felt strongly that I should continue using an IUD and not undergo an elective, irreversible procedure. Fair enough - elective surgery is a big deal and should not be undertaken lightly. To their credit, this particular doctor didn't imply that I was going to change my mind about having kids, although I've heard that sentiment often enough from people both in and out of the medical profession.
And along came Dobbs, throwing into question future access to abortions and family planning measures.
I'd been having increasing breakthrough bleeding and cramping that was occurring at a higher frequency and intensity. Fighting the urge to puke or curl up on the floor because your body has decided that it really wants to not have this particular uterine lining is not an experience I would wish on anyone. Factoring in the changing political climate and open attacks on reproductive rights and access, I decided to ask about getting sterilized again. At this point, if something happened and I needed to terminate a pregnancy, odds are good that it would be a serious struggle and may involve air travel.
This is how I know that my OBGYN is utterly amazing. Seriously, everyone deserves my OBGYN. I went in to an annual exam and told him I'd like to be sterilized. My doctor didn't even blink - he asked me if I wanted kids (prefaced by "I know we've talked about it, but I need to make sure.") and then inquired if I'd thought about what kind of sterilization I'd like. We talked about my cramping and agreed that a hysterectomy was the best fit. When I expressed concern about hormone replacement, he explained that they would leave my ovaries, so no early menopause for me. At no point did my husband come up, although I was prepared to lie and say he'd had a vasectomy to nip any issues in the bud. My body, my choice, no pressure either way.
As I said, everyone deserves my OBGYN.
Both my doctor and I expected to have to fight with my insurance to get the procedure covered. When I'd looked into sterilization in the past, it required a pre-authorization and a bunch of hoops to jump through, including an ultrasound, switching birth control methods to try and "mitigate the symptoms", and swearing up and down that your spouse also doesn't want kids. In short, while a vasectomy takes almost no effort to get covered, female sterilization generally requires you to prove that you're willing to persevere to make choices about your reproduction (or lack thereof).
Therefore, we were pleasantly surprised when my insurance didn't require a pre-auth. In fact (much credit to government health insurance), male and female sterilization were both covered. Can you say "equality in healthcare", anyone?
As you have probably guessed by now, I had a vaginal hysterectomy. The procedure went smoothly, my blood glucose levels behaved (shocking, I know), and I'm now at home playing the recovery game. Pacing around, not lifting, drinking lots of water, and generally going a little bit stir crazy because this is the longest I haven't exercised in over a year.
The day before my procedure I had a (to be expected) "what the hell am I doing" moment. Elective surgery, especially as a diabetic and someone with a history of being complicated in a hospital setting, is nothing to be taken lightly. While I've never wanted kids, what if that changes? What if I'm the one in a thousand who winds up with a perforated bladder or prolapse? In my case, the answers come easy (adoption, don't overdo it and things will be fine), but it's always worth taking stock before making an irreversible decision. For me, the certainty of never having another menstrual cramp and never having to worry about access to abortions if, god forbid, I needed one, outweigh the risk and uncertainty.
My parents made sure to run through the "what if" list with me. What if something happens to Ev and a future partner wants kids? (that won't change my not wanting them, and also, adoption). What if I change my mind about kids in a couple years? (adoption). They reminded me that raising a family opens up a totally different set of experiences that many people find incredibly fulfilling. And adoption is not an easy process - it can take years and be incredibly stressful and expensive. There are no easy paths or answers. What's right for me may not be right for others.
My body, my life, my choice.
Post-script: the pathology report showed that I had endometriosis and a chronically inflamed cervix. Turns out, period pain was not in my head. Also turns out that endometriosis can be hard to diagnose. I'm extremely grateful that my doctor believed me and didn't question my experiences and complaints.
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If someone asks whether the Dobbs decision was a factor in my choice to get sterilized, the answer is a resounding "yes". While it was not the driving factor, I've been watching reproductive rights get eroded for years. Making this choice while it's still available was absolutely part of my mental calculus. I am now in a position where the lack of training of medical students on abortion procedures (even the ones that involve ectopic pregnancies) will no longer effect me. Where local legislation surrounding abortion no longer applies. Where access to contraceptives and routine screenings are no longer of concern.
But I had to have an organ removed to get here.
I am not advocating people go get sterilized to protest Supreme Court rulings. Body autonomy means that everyone deserves the right to make choices about their body. Have kids (or don't). Take advantage of family planning resources (or don't). Be open about your reproductive choices and struggles (or don't).
My body, my choice. Your body, your choice. But if you want to keep it that way, I suggest you think long and hard about how you vote and what the knock-on effects might be. Reproductive rights are so much more than abortion access, and limiting them can be so much worse than simply forcing women to have an unwanted pregnancy.
To quote a friend:
"If you don’t want women dying, then they need to be provided access to the medical procedures they need. Anti-abortion laws hurt all women, not just those who make the choice to terminate a living pregnancy. Limiting reproductive healthcare will lead to unnecessary deaths of our sisters, cousins, friends, & many other women in our lives. I’m speaking from a place of deeply personal experience. I’m grateful that I’m still alive. My hope is that ALL women have access to experienced reproductive health facilities if they also find themselves in the position of needing a safe procedure."
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