Sterilization as Cyborg Performance: Reproductive Freedom and the Regulation of Sterilization

Upon requesting a sterilization, a young woman with no children reported that a physician told her to “go away and come back when you are married.”¹ When seeking a sterilization in her midtwenties, a friend of mine who had no children was turned away by medical professionals who did not take her request seriously. In her own words: “After being rebuffed by my family doctor, I contacted the local Planned Parenthood and was unequivocally told that no local doctor, whether associated with Planned Parenthood or not, would perform the operation on a twenty-three-year-old woman who would likely change her mind.” After moving to California and after “three ‘are you sure?’ screening interviews,” she was finally sterilized.

Sterilization through the ligation of the fallopian tubes is a common form of contraception in the United States.² Of American women who use contraceptives 27 percent rely on tubal ligation. It is the most common form of birth control among thirty-to thirty-five-year-old women, as well as black and Hispanic women of all ages.³ Before the passage of the Affordable Care Act in 2010 roughly 85–90 percent of private health insurance plans covered sterilization. In January of 2012 the Obama administration announced that under the new health care law health insurance plans would be required to cover female sterilization without a copayment or deductible.⁴ Public funding is also available for sterilization, and it is generally covered as a family planning service under Medicaid.⁵ However, compared to women with private insurance, women on Medicaid face more barriers to accessing postpartum sterilization because of the thirty-day waiting period between consent and sterilization that is in place to prevent involuntary sterilization.⁶ Despite this barrier, in 1990 female sterilization rates were highest for “less-educated, low-income and minority women of all ages.”⁷

Because those who have studied the characteristics of women who get sterilized tend to assume that it is a procedure undergone when a woman has completed her childbearing, there are no accurate assessments of the numbers and characteristics of women without children who seek sterilization. The limited research that there is, along with journalistic accounts of sterilization, suggests that young women without children, like those quoted above, frequently have difficulty finding a physician willing to ligate their fallopian tubes.⁸ Rates of voluntary childlessness, which may be correlated to sterilization rates, are generally lower among black and Hispanic women than white women, though a 1989 study shows that the disparity in rates between black and white women disappears when class is taken into account.⁹

Despite the lack of data on access to sterilization and the characteristics of women seeking it, the refusal or reluctance of medical practitioners to ligate some women’s fallopian tubes calls for critical examination in part because it is an impediment to reproductive freedom. The inaccessibility of sterilization limits some women’s ability to carry out their reproductive decisions. Additionally, impediments to sterilization access limit reproductive freedom because they both reflect and contribute to what Katherine Franke has called “repronormativity,” which is the normative framework that encourages reproduction and takes reproductive desire as a given.¹⁰ Cultural understandings that align female identity with motherhood play a role in producing and reinforcing ideas about the naturalness and inevitability of reproductive desire and thus delimit the range of acceptable reproductive behaviors and desires.

Franke has urged feminist theorists to “reconceptualize procreation as a cultural preference rather than a biological imperative, and then explore the ways in which to lessen or at least modify the demand to conform to that preference.”¹¹ In this article I show that the negative reactions of medical professionals to some women’s requests for sterilization are manifestations of the notion that procreation is a biological imperative. To move closer to reproductive freedom, the difficulties some women face in getting sterilized as well as underlying beliefs about reproductive desire and women’s bodies need to be addressed. To the extent that repronormativity limits reproductive freedom, challenging repronormativity and associated beliefs is an important element of projects...