The bleeding began at 10 pm on Saturday, July 22.
Paula* (Chilean, 30) was at home. She thought it was menstruation, but after a while she got scared. There was too much pain and blood.
He decided to go to the hospital. Upon arrival, the doctors told her: “You had a loss, a miscarriage.”
His surprise was complete. Such news was not expected.
Paula made a decision many years ago: I didn’t want to be a mother under no circumstances.
Her birth control pills didn’t work for her, and she again regretted that no doctor was willing to perform the operation. Surgical sterilizationthe desire he had since the age of 18.
“If my tubes had been tied, none of this would have happened. It was an unpleasant experience and I am angry because I spent years looking for a professional who help me fulfill my wish not to be a mother.”he tells BBC Mundo in an interview just days after the loss.
What is it and what are its requirements?
Paula represents the thousands of women in Latin America who cannot undergo voluntary surgical sterilization, better known as tubal ligation.
This procedure is effective over 99% to prevent pregnancymaking it one of the safest methods available.
The World Health Organization (WHO) actually classifies it as a “very effective” contraceptive.
It also does not affect hormone levels in the body (as well as other contraceptives), which for many women is a significant advantage, as it has no “side effects”.
How does tubal ligation work?
- Female sterilization prevents eggs from passing through the fallopian tubes, which connect the ovaries to the uterus.
- This means that the woman’s eggs cannot meet the sperm, so fertilization cannot occur.
- There are various ways to block the fallopian tubes: using clamps, silicone rings, tying, or cutting a small piece of the fallopian tube.
- This is a relatively simple operation that is usually performed on an outpatient basis. Done through laparoscopy.
Its main difference from other methods of preventing pregnancy, such as pills, intrauterine devices, vaginal ring, patches or injectable ampoules, is that it is permanent and irreversible.
This can be an important benefit for those women who decide not to have children because they never have to worry about it again: not taking a daily pill, not changing the device every month, not continuing to spend money on contraceptives.
However, for many doctors, this is the main reason that leads to refrain from doing it.
Especially if the woman is young and has no children.
This happens even in countries where access to the procedure is allegedly guaranteed by law.
This is the case Colombia, Argentina, Brazil, Mexico or Chile, where it is considered a “reproductive right”.
In order to encourage responsible motherhood and fatherhood, most of these countries propose as a requirement that a woman adultsend a request in writing (by signing informed consent) and before the procedure is exposed to sexual and reproductive health counseling the attending physician.
But, according to women and experts interviewed by BBC Mundo, in many cases the above turns into a series of obstacles that make it very difficult access to tubal ligation.
This is the case of Paula, who expressed her desire to be sterilized three times, always getting a negative response in the consultations given by her doctor.
“The first time I applied for this was at the age of 23 in the Chilean public system. The doctor told me no, that I was very young, that I hadn’t finished university yet, that I was going to change my mind,” she says.
“The second time I was 25 years old, and the answer was the same: that he was not mature enough to make such a decision. And for the third time, just 3 years ago, they categorically closed the door to me, saying that if I want a ligation of the fallopian tubes, I should ask for it abroad.
Her recent pregnancy, albeit an unsuccessful one, puts her on guard.
“With other contraceptives, you can always fail. That’s the problem,” he says.
“I already want to forget about it. I can’t,” he adds.
Waiting lists
One of the biggest problems faced by women who want to access this procedure for free is that long waiting lists which exists in a large proportion of public health institutions in Latin America.
And for women who do not have children, the situation is even more difficult.
“In the state system, the queues are huge, and women without children are not a priority. For this reason, they are being pushed to take care of themselves with other methods of contraception, ”comments the gynecologist-obstetrician. Gabriel Zambranofrom the Itenu Medical Center in Caracas, about the reality of Venezuela, which is repeated in different countries of the region.
According to the latest UN report on family planning, The covid-19 pandemic has exacerbated this situation, reducing the availability of and access to contraceptive services for women, especially those with irreversible effects such as sterilization.
The UN says the reality is worse in low- and middle-income countries and among the most vulnerable.
Thus, voluntary sterilization is much more accessible to women who can pay for it privately.
This is the case Amanda Trevilaa Chilean woman who, at 34, achieved sterilization after asking for it for 16 years.
“In the public system, no one wanted to operate on me because I was very young or because I had no children… So I ended up in the private system. And it’s very expensive. This is the biggest hurdle of all,” he told BBC Mundo.
Amanda had to pay 4 million Chilean pesos (approximately $4,800).
“They can tell you everything, the questions are very difficult. And you have to face them. But if you don’t have money, everything goes to waste,” he points out.
Gender bias?
But there is also a cultural problem.
That’s how he makes sure Franziska Crispidoctor, academician and president of the Medical College of Santiago de Chile, who has devoted years to studying the issue of women’s sexual rights.
“In Latin America, there is a problem of women’s autonomy in the doctor-patient relationship. The prejudice that women cannot make their own decisions, that they are very emotional,” he warns.
“There is an opinion that all women should want to be mothers, and if they don’t want it at the moment, later regret it”add.
Indeed, gynecologist-obstetrician Gabriel Zambrano states that “the biggest fear we have is that a woman will regret it … we doctors can be accused of cutting off a patient’s fertility.”
However, for the women interviewed by BBC Mundo, this fear of remorse experienced by doctors often means that their reproductive rights and freedom of choice.
“There is an opinion about women in which we are infantilized, made to think that our decisions are hasty without thinking about them,” says Paula.
To all this are added religious arguments.
“There are centers that do not provide certain contraceptives for religious reasons, although conscientious objection is not regulated in this case,” says Crispi.
On the other hand, the academician assures that, despite the fact that in many countries the law specifies that women do not need your partner’s consent to access this procedure (for example, in the case of Argentina or Colombia), the reality is that there are still medical centers that request it.
“We have a lot of cases where they ask the couple for their opinion and that becomes a big hurdle,” he says.
Paula recalls that this was exactly one of the questions she received when she expressed her desire to have her tubes tied.
“It’s like your husband owns your decisions. It’s a very archaic and patriarchal view because it’s a personal decision,” he says.
In the case of Spain, the situation is different.
according to the doctor Jose Cruz Quilespresident of the Spanish Society for Contraception (SEC), no further questions arise if the woman has not had children.
“Here, if a woman wants her tubes tied, the procedure is done whether she was a mother or not,” she explains.
“That is their right,” he adds.
For Franziska Crispi, all the barriers that exist in Latin America are problematic, because contraception is time dependent.
“If a woman is denied, it may mean that she has an unwanted pregnancy in the near future. Therefore, this rejection of certain types of contraception seems problematic to me, ”he notes.
The above becomes even more relevant if we take into account the UN numbers on unwanted pregnancies: according to an international organization, between 2015 and 2019 there were 121 million such pregnancies, accounting for 48% of all pregnancies.
Some data:
- According to the United Nations, female sterilization is the most widely used contraceptive method in the world.
- According to the latest Family Planning Report, 219 million women gained access to female sterilization in 2020, which corresponds to 23% of women using contraceptives.
- Male sterilization, on the other hand, is much lower, with 17 million men being treated, which is 1.8%.
- According to the UN, the Dominican Republic, El Salvador, Mexico and Colombia are the countries in the region where the prevalence of female sterilization is highest.
“Finally it’s over”
Two years after her sterilization, Amanda Travela says she feels “calm and happy.”
She remembers that when she entered the room to have surgery, a midwife in her 50s approached her to tell her something she would never forget.
“He told me: “I think what you are doing is very valuable. I did not belong to your generation, which can make such decisions. I never wanted to have children, but no one ever wanted to operate on me. I will take care of you here.”
Amanda claims that it was there that she realized she was part of “a community of women who live with this pain of obstacles, questions, as if we were emotionally and hormonally weak.
Waking up after the operation, Amanda began a new life. “I felt infinite peace.
I thought, “It’s finally over.”
Today, Paula lives in a different reality.
Having barely recovered from a recent abortion, she says that she no longer has the strength to continue trying to achieve sterilization.
“Maybe in a few years I’ll run into someone who thinks I’m of a reasonable age and mature enough to have my tubes tied.”
“In the meantime, my partner is going to have a vasectomy. because they don’t give him problems and don’t ask his age, whether he had children or not,” he points out with obvious displeasure.
*Paula is a fictitious name because the interviewee did not want to reveal his identity for personal reasons.
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