Access to Female Sterilization as Perceived by History of Medicine Students

Blog by Caitlin Fendley

I teach a course on the history of disease, death, and medicine in twentieth-century America, which is predominantly taken by STEM and pre-med students and those seeking to work in healthcare. As part of teaching students about how culture and medicine influence each other, I devote lectures to women’s reproductive health activism. Most students already know the story of second wave feminism and are familiar with Roe v. Wade. They are aware of the invention of “the Pill” and how it revolutionized women’s personal, sexual, and work lives. Some also knew about the dark legacy of eugenics and how this movement has led to compulsory sterilization across the globe. Students are much less familiar, however, with women’s past and current struggles to access permanent voluntary sterilization.

We discussed how many women, then and now, have fought with physicians for the right to be sterilized. As Rebecca Kluchin discusses in Fit to be Tied: Sterilization and Reproductive Rights in America, 1950-1980, it was not uncommon for hospitals and physicians to place restrictions on women, requiring spousal consent and psychiatric evaluation to be deemed “mentally fit” to become sterilized. Age-parity restrictions (a woman’s age multiplied by her progeny) for sterilization were often arbitrary, making the surgery a huge obstacle especially for young, childfree women.

I asked students to reflect on the following: “What do you think about cases where women are denied sterilization surgery, sometimes repeatedly for years? Is this a denial of a woman’s reproductive rights?” Seventy-four of 75 of my students agreed that it was a violation of women’s reproductive rights to deny her sterilization surgery if she truly desired it. Though some noted the factors both physician and patient needed to consider, they still determined that if a woman knew the risks involved, then it was violating her reproductive choice to not perform the surgery. Although they are not medical professionals themselves and may not have known much more about sterilization surgery than what they learned in class, their response is interesting given the historical and current controversies the procedure has maintained.

Through a reproductive justice lens, it is legal and ethical to provide the surgery; students seemed surprised to learn that many women still struggle to become sterilized. Though this partly reflects medicine as an inherently patriarchal system within a pronatalist society, it also demonstrates the importance of challenging an unfair and sexist obstacle within women’s healthcare. Women’s access to reproductive services have a long, complex history, in which freedoms or restrictions have reflected societal and political values and debates over bodily autonomy. Although a significant portion of the problem lies in inconsistent sterilization laws across the United States, another issue involves the continued cultural stigma that prioritizes a woman’s ability to reproduce over her choice of birth control.

To challenge this system is to first recognize the attitudes which reinforce it. Many of my students will go on to work in healthcare fields and will be part of a medical system which deems too many women too inept to make their own reproductive decisions. Although medical school students do devote time to recognizing and challenging personal biases which may interfere with their ability to impartially care for future patients, it is important to give them the time and space to more carefully reflect on issues which will arise in their healthcare practices. And even for those who will not work in healthcare, it is nonetheless important to be aware of these barriers within women’s healthcare. Medical humanities can help with this. This field is essential to teaching students about social and cultural issues of medicine and healthcare. The history of medicine helps students make connections between the past and present, and recognize how deep-seated biases within American culture continue to influence medical institutions and decision making. In particular, those who teach the history of women’s health and medicine should consider covering voluntary sterilization to bring greater awareness to this issue.

Increasing student access to these personal and social ideas not only gives them greater awareness of how culture influences medicine in many ways, but teaches that they can be part of the broader, positive changes taking place within women’s reproductive healthcare. Although my students overwhelmingly supported a woman’s right to choose, I expected that giving them a place to reflect and discuss this issue more openly would help them recognize that, even half a century after the women’s rights movement, American women continue to face significant healthcare barriers. Hopefully, the surprise my students expressed at this reality demonstrates changing cultural attitudes which will effectively help to transform the future of women’s reproductive rights.

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