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50 Women seeking permanent contraception in the late 1960s confronted several barriers. These included the ambiguous legal status of sterilization, which led some doctors to refuse to perform the surgery for fear of litigation, and age/parity restrictions, which barred young women with small families from obtaining the desired surgery. The high cost of and medical risks associated with tubal ligation also stymied many women. By the early 1970s, advances in surgical technology reduced the costs and the risks of tubal ligation, making the surgery more accessible and attractive to women. Until this time, tubal ligation was open abdominal surgery that required general anesthetic, and several days in the hospital, and included a six-week recuperation period. This changed when physicians revolutionized the technology of female sterilization by introducing laparoscopic methods that significantly reduced the cost and duration of surgery and minimized the medical risks involved, effectively making the procedure safer, more affordable, and less disruptive to women’s lives and health. The combination of the AVS’s campaign, women’s changing expectations of their contraception, and advances in surgical technology intersected to transform sterilization from a procedure associated with eugenics to one of the most popular methods of contraception in the country. Many couples determined to prevent unplanned pregnancy via surgery found that while tubal ligation was out of reach, vasectomy was not. Most vasectomies were performed in physicians’ offices, outside the purview of hospital administrators and policies like the 120 rule, and were far less expensive than tubal ligation. Hundreds of thousands of couples intent on limiting family size turned to vasectomy as a “solution” to their contraceptive problems, and in “Fit” Women and Reproductive Choice Chapter 2 doing so, granted men a rather unprecedented responsibility for birth control. Likewise, as public concern about overpopulation grew in step with a swelling population control movement, men of all ages concerned about the problem chose to be sterilized as a political act, as a way of “doing their part” in the struggle to limit population size and environmental “dangers” caused by large numbers of people. Of course, men have used condoms for centuries, but condoms do not alter the body’s chemistry or physicality like the Pill and IUD do, and as such do not involve the same levels of commitment and risk that women who use these methods assume. The increasing use of vasectomy signaled both a new trend in contraceptive decision making between couples and the medicalization of male contraception. Since the 1930s, physicians dispensed the most effective methods of female contraception (the diaphragm, the Pill, and the IUD), while the most popular method of male birth control, the condom, remained available in drugstores and without a prescription. As vasectomy gained popular and medical support, men found themselves following women and turning to physicians for help controlling their reproduction. Men who had a vasectomy also assumed a historically female responsibility for birth control. Having adopted a method that was nearly foolproof, these men released their partners from the duty of employing contraception and the worry that it might fail. Sterilization as an Alternative Contraceptive The introduction of the Pill in 1960 and the redesign of the IUD in 1964 caused women to revise their expectations regarding contraception. These technologies offered women reliable birth control that did not interfere with the sex act, existing as attractive alternatives to less-effective, messy diaphragms, jellies, and condoms. The Food and Drug Administration (FDA) approved the first birth control pill, Enovid, in 1960, and within five years of its arrival on the market, the Pill became the most popular form of contraception in the country. The introduction of the Pill to the United States market ushered in new contraceptive behaviors and created a cultural phenomenon. Eager to try the revolutionary technology, millions of women (largely white and middle class) began to demand that their physicians prescribe the Pill for them. Their demands shifted the balance of power in the doctor-patient relationship to grant more authority to women, who assumed the role of health care consumer. In the 1960s, women entered doctors’ offices with their own diagnoses and treatment plans; they wanted to avoid pregnancy and to take the Pill. Generally, patients approach physicians for medical advice and assistance, assuming a submissive position, which was magnified for women on account of their sex. But women seeking the Pill rejected this model in favor of a more consumer-based one in “Fit” Women and Reproductive Choice 51 [3.17...

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