Tubal ligation? Not for everyone

In 2018, Anne Njeri* became pregnant with her second baby. Because the pregnancy was high risk, she had to undergo a caesarian section.

However, before she was wheeled to the theatre, she asked her doctor to tie her fallopian tubes a process known as tubal ligation after the surgery. She had made a decision not to have other babies. 

“I was so sure that I needed no more children in the future and that is why I was opting for tubal ligation as a permanent birth control method. I was 30 years then,” she says.

Tubal ligation is a surgical procedure in which the fallopian tubes are permanently blocked, clipped, or removed. It is also called female sterilisation and a permanent method of birth control.

However, Njeri shares how after making that request, the doctor couldn’t agree to it. He argued that she was still young and might end up changing her mind and wanting more children. Njeri further shares how even a few friends who she had told her intentions were very much against it. She was advised to wait until she was 40 years old to have that surgery. 

Uphill task

“The doctor said that the surgery can’t be done because I was still young and might change my mind later. Apart from that, he alleged that conducting the surgery might land his team in trouble since I might end up suing them. I didn’t seek a second opinion. I just left it at that,” she says.

Another woman, Rose Akinyi shares how, though she was lucky to have tubal ligation done, it was an uphill task to even find a doctor willing to consider her request. Her gynaecologist kept saying that her husband would in the future want children and ‘she won’t be able to give them to him’ because tubal ligation is a permanent method.

 It was only after her husband went to see the gynaecologist that he agreed to perform the surgery. And once she did, she faced endless questions about her decision. 

 “The funny thing was even when I was being wheeled to the theatre for an emergency CS, the nurse asked me whether my husband had consented to the tubal ligation. Sadly, women have to get permission from their husbands to get such a procedure done, whilst men do not need any permission to get a vasectomy,” says Rose.

She shares how though cases of women who want to take up permanent birth control methods are going up, many women have expressed frustrations over the difficulties to have it done.

Hurdles such as high costs for such procedures to denials from medical professionals who insist they are ‘too young’ and claim they may well change their mind in the future are the most common for women trying to seek these services.

“Tubal ligation should be seen as a family planning method just like any other. If one is done with having children and is sure she does not want more, she should have it done. What’s the point of pumping hormones and metals into your system yet you have no plans of having more babies?” posed Rose.

There’s also a misconception, where some people believe that women who do not reproduce are ‘empty’ or unfulfilled. These cultural norms add women who get permanent method of birth control to this category.

Common fears and cultural beliefs

“Society will always have opinions, but at the end of the day, the babies you sire are your responsibility. Society won’t lift a finger to help you raise them. My two cents, have the number of babies you want and choose whatever method of family planning you want guilt-free,” Rose says.

But why is tubal ligation still a taboo in most African countries and what can be done to change this mindset? Dr Fredrick Kairithia, obstetrician, gynaecologist and public health practitioner who also doubles up as the Chairman of the Kenya Obstetrical and Gynecological Society (KOGS) Nairobi Branch says that the method is largely taboo or least discussed due to a lot of misconceptions about the procedure. Ideologies and cultural beliefs about female roles also add to the complexity of this issue.

“Also, there are many common theories such as interfering with sex life (libido), interfering with hormones,  where some people believe that the inability to allow passage of eggs affects women. There is also the common fear that since this is a permanent method, it denies the couple the ability to change their mind and have other babies should they decide,” says Dr Kairithia.

Dr Kairithia, however, argues that no one should be denied the procedure and made to feel incapable of making this permanent decision. But one of the requirement that must be met before one is allowed to undertake the procedure is that one must be certainly clear that they don’t want to have (more) babies owing to the irreversibility of the method. 

Complexity of the issue

They must also be able to demonstrate they understand and can give valid consent for the procedure. This protects women from being coerced or manipulated to take the permanent method. 

“The reason as to why this is a requirement is because this is a form of permanent contraception, which should only be provided to persons who no longer want to have babies or those with a complete number of children they desire,” says Dr Kairithia.

And are women allowed to make this decision alone? “Though most doctors require the couple to make this decision together, legally, women can consent on their own so long as they indemnify the care provider due to the irreversibility of the procedure,” Dr Kairithia says.