Editing Sterilization (medicine) (section)

==Voluntary (Elective) Sterilization==

Motivations for voluntary sterilizations include:

===Lifestyle===
Because of the emphasis placed on childbearing as the most important role of women, not having children was traditionally seen as a deficiency or due to fertility problems.<ref name="Childfree and Feminine"/> However, better access to [[contraception]], new economic and educational opportunities, and changing ideas about motherhood have led to new reproductive experiences for women in the [[United States]], particularly for women who [[Voluntary childlessness|choose to be childless]].<ref name="The Perspectives of Childless Couples">Forsyth, Craig J. 1999. "The Perspectives of Childless Couples". ''International Review of Modern Sociology''. 29(2): 59–70.</ref> Scholars define "voluntarily childless" women as "women of childbearing age who are fertile and state that they do not intend to have children, women of childbearing age who have chosen sterilization, or women past childbearing age who were fertile but chose not to have children".<ref name="Women's Voluntary Childlessness">Kelly, Maura. 2009. "Women's Voluntary Childlessness: A Radical Rejection of Motherhood?". ''Women's Studies Quarterly''. 37(3/4): 157–172.</ref> 

In industrialized countries such as the [[United Kingdom]], those of [[Western Europe]], and the [[United States]], the [[fertility rate]] has declined below or near the population [[replacement rate]] of two children per woman. Women are having children at a later age, and most notably, an increasing number of women are choosing not to bear children at all.<ref name="Childfree and Feminine">Gillespie, Rosemary. 2003. "Childfree and Feminine: Understanding the Gender Identity of Voluntary Childless Women". ''Gender and Society''. 17(1): 122–136.</ref> According to the [[United States Census Bureau|U.S. Census Bureau]]'s American Community Survey, 46% of women aged 15 to 44 were childless in June 2008 compared to 35% of childless women in 1976.<ref name="Fertility of American Women: 2008">2010. "Fertility of American Women: 2008". American Community Survey. United States' Census Bureau.</ref> The personal freedoms of a childless lifestyle and the ability to focus on other relationships were common motivations underlying the decision to be voluntarily childless. Such personal freedoms included increased autonomy and improved financial positions. 

In relationships, the couple could engage in more spontaneous activities because they did not need a babysitter or to consult with someone else. Women had more time to devote to their careers and hobbies. Regarding other relationships, some women chose to forgo children because they wanted to maintain the "type of intimacy that they found fulfilling" with their partners.<ref name="Childfree and Feminine" /> Although voluntary [[childlessness]] was a joint decision for many couples, "studies have found that women were more often the primary decision makers. There is also some evidence that when one partner (either male or female) was ambivalent, a strong desire not to have children on the side of the other partner was often the deciding factor."<ref name="Women's Voluntary Childlessness" /> 'Not finding a suitable partner at an appropriate time in life" was another deciding factor, particularly for ambivalent women.

===Financial===
Economic incentives and career reasons also motivate women to choose sterilization. Regarding women who are voluntarily childless, studies show that there are higher "opportunity costs" for women of higher socioeconomic status because women are more likely than men to forfeit labor force participation once they have children. Some women stated the lack of financial resources as a reason they remained [[childfree]]. Combined with the cost of raising children, having children was viewed as a negative impact on financial resources.<ref name="Women's Voluntary Childlessness"/> Thus, childlessness is generally correlated with working full-time. "Many women expressed the view that women ultimately have to make a choice between motherhood and career." In contrast, childlessness was also found among adults who were not overly committed to careers. Here, the importance of leisure time and the potential to retire early was emphasized over career ambitions.

Sterilization is also an option for low-income families. Public funding for contraceptive services comes from a variety of federal and state sources in the United States. Until the mid-1990s, "[f]ederal funds for contraceptive services [were] provided under [[Title X]] of the [[Public Health Service Act]], Title XIX of the [[Social Security (United States)|Social Security]] (Medicaid), and two block-grant programs, [[Maternal and Child Health Bureau|Maternal and Child Health]] (MCH) and Social Services."<ref name="Public Funding of Contraceptive">Gold, Rachel Benson and Barry Nestor. 1985. "Public Funding of Contraceptive, Sterilization, and Abortion Services". ''Family Planning Perspectives''. 17(1): 25–30.</ref> The [[Temporary Assistance for Needy Families]] was another federal block granted created in 1996 and is the main federal source of financial "welfare" aid. The U.S. [[Department of Health and Human Services]] administers Title X as the sole federal program dedicated to family planning. Under Title X, public and nonprofit private agencies receive grants to operate clinics that provide care largely to the uninsured and the underinsured. Unlike Title X, [[Medicaid]] is an entitlement program that is jointly funded by federal and state governments to "provide medical care to various low-income populations".<ref name="Methodology for Measuring Public Funding for Contraceptive">Sonfield, Adam, and Rachel Benson Gold. 2005. "Methodology for Measuring Public Funding for Contraceptive, Sterilization, and Abortion Services, FY 1980–2001". The Alan Guttmacher Institute.</ref> Medicaid provided the majority of publicly funded sterilizations. In 1979, regulations were implemented on sterilizations funded by the [[United States Department of Health and Human Services|Department of Health and Human Services]]. The regulations included "a complex procedure to ensure women's informed consent, a 30-day waiting period between consent and the procedure, and a prohibition on sterilization of anyone younger than 21 or who is mentally incompetent."<ref name="Methodology for Measuring Public Funding for Contraceptive" />

===Physiological===
Physiological reasons, such as disease, genetic disorders, or disabilities, can influence whether individuals seek sterilization. For example, females may choose to undergo sterilization procedures as a form of treatment for certain diseases. In individuals with [[endometriosis]], a [[hysterectomy]], sometimes along with an [[oophorectomy]], may be a viable treatment option, although it is often a last resort.<ref>{{Cite web |date=2024-05-16 |title=Hysterectomy for endometriosis: Pros and cons |url=https://www.medicalnewstoday.com/articles/pros-and-cons-of-hysterectomy-for-endometriosis |access-date=2025-02-28 |website=www.medicalnewstoday.com |language=en}}</ref> Another reason may include individuals who choose sterilization in order to concentrate on caring for a child with a disability and to avoid withholding any necessary resources from additional children. For individuals without children, technological advancements have enabled the use of carrier screening and [[prenatal testing]] for the detection of [[genetic disorders]] in prospective parents or their unborn offspring.<ref name="Genetic Screening: Marvel or Menace?">Rowley, Peter T. "Genetic Screening: Marvel or Menace?". 1984. ''Science''. 225(4658): 138–144.</ref> If prenatal testing has detected a genetic disorder in the child, parents may opt to be sterilized to forgo having more children who may also be affected.<ref name="Child Disability and Mothers' Tubal Sterilization">Park, Jennifer M., Hogan, Dennis P. and Frances K. Goldscheider. 2003. "Child Disability and Mothers' Tubal Sterilization". ''Perspectives on Sexual and Reproductive Health''. 35(3): 138–143.</ref>

=== Barriers to Elective Sterilization ===
Individuals who desire to undergo elective sterilization may face barriers to accessing these procedures. In the [[United States]], there has been a growing demand for sterilization procedures, especially among women.<ref name=":3">{{Cite news |title=More people are opting to get sterilized — and some are being turned away |url=https://www.npr.org/sections/health-shots/2022/07/29/1113573995/more-people-are-opting-to-get-sterilized-and-some-are-being-turned-away |access-date=2025-02-27 |work=NPR |language=en}}</ref> This is thought to be at least partially due to the Supreme Court's decision to overturn ''[[Roe v. Wade]]'' in 2022, leaving the fate of abortion rights uncertain.<ref name=":3" /> However, due to skepticism from medical providers, cost, and insurance issues, many individuals desiring sterilization have been denied or prevented from undergoing the procedures.<ref name=":3" /> Patients of childbearing age without children report difficulty in finding physicians who are willing to perform sterilizations.<ref name=":3" /> In the [[United States]], insurance companies differ in the extent to which they cover sterilization procedures. Under the [[Affordable Care Act]], [[Food and Drug Administration|FDA]]-approved female sterilization procedures are covered when prescribed by a physician.<ref name=":4">{{Cite web |title=Birth control benefits and reproductive health care options in the Health Insurance Marketplace® |url=https://www.healthcare.gov/coverage/birth-control-benefits/ |access-date=2025-02-27 |website=HealthCare.gov |language=en}}</ref> However, male reproductive procedures, like [[Vasectomy|vasectomies]], are not required to be covered.<ref name=":4" /> These differing levels of coverage may create cost barriers, preventing some individuals desiring sterilization procedures from accessing them. 

In the [[United States]], men also encounter barriers when seeking elective sterilization procedures, particularly vasectomies. Despite being a safe and effective form of birth control, the U.S. has the lowest [[vasectomy]] rate among wealthy nations.<ref name=":6">{{Cite web |last=twkett@bu.edu |date=2022-08-31 |title=Do Men Face Barriers to Birth Control? |url=https://publichealthpost.org/sexual-reproductive-health/vasectomy-barriers/ |access-date=2025-04-11 |website=Public Health Post |language=en-US}}</ref> This can be attributed to both cultural attitudes and structural obstacles within the healthcare system. Misinformation continues to surround the procedure, such as the misconception that a vasectomy undermines masculinity, contributing to hesitation and stigma.<ref name=":6" /> At the same time, systemic barriers further limit access. Insurance limitations and provider attitudes often restrict who can undergo the procedure. Because vasectomies are not covered under the [[Affordable Care Act|Affordable Care Act (ACA)]], men may face out-of-pocket costs of up to $1,000.<ref name=":6" /> Additionally, while any man over 18 is legally eligible, some providers refuse to perform the procedure on younger patients or those without children, creating another barrier for those seeking sterilization.<ref name=":6" /> 

===National examples===

====United States====
Sterilization is the most common form of contraception in the United States when female and male usage is combined. However, usage varies across demographic categories such as gender, age, education, etc. According to the [[Centers for Disease Control and Prevention]], 16.7% of women aged 15–44 used female sterilization as a method of contraception in 2006–2008, while 6.1% of their partners used male sterilization.<ref name="Use of Contraception in the United States: 1982-2008">2010. "Use of Contraception in the United States: 1982–2008". ''Vital and Health Statistics''. 23(29)</ref> Minority women were more likely to use female sterilization than their white counterparts.<ref name="Female Sterilisation in the United States">Zite, Nikki and Sonya Borrero. 2011. "Female Sterilisation in the United States". ''The European Journal of Contraception and Reproductive Health Care''. 16: 336–340.</ref> The proportion of women using female sterilization was highest for black women (22%), followed by Hispanic women (20%), and white women (15%).<ref name="Use of Contraception in the United States: 1982-2008" /> Reverse sterilization trends by race occurred for the male partners of the women: 8% of male partners of white women used male sterilization, but it dropped to 3% of the partners of Hispanic women and only 1% of the partners of black women.<ref name="Use of Contraception in the United States: 1982-2008" /> White women were more likely to rely on male sterilization and [[the pill]]. While use of the pill declined with age, the report found that female sterilization increased with age.<ref name="Use of Contraception in the United States: 1982-2008" /> 
[[File:U.S. Sterilization by Race chart.png|U.S. Sterilization by Race chart|right]]

Correspondingly, female sterilization was the leading method among currently and formerly married women; the pill was the leading method among cohabiting and never married women. 59% of women with three or more children used female sterilization. <ref name="Use of Contraception in the United States: 1982-2008" /> Thus, women who do not intend to have more children primarily rely on this method of contraception in contrast with women who only aim to space or delay their next birth. Regarding education, "less-educated women aged 22–44 years were much more likely to rely on female sterilization than those with more education."<ref name="Use of Contraception in the United States: 1982-2008" /> For example, female sterilization was used among 55% of women who had not completed high school compared with 16% of women who had graduated from college.<ref name="Use of Contraception in the United States: 1982-2008"/>

Because national surveys of [[Birth control|contraceptive]] methods have generally relied on the input of women, information about male sterilization is not as widespread. A survey using data from the 2002 National Survey of Family Growth found similar trends to those reported for female sterilization by the Centers for Disease Control and Prevention in 2006–2008. Among men aged 15–44 years, vasectomy prevalence was highest in older men and those with two or more biological children.<ref name="Contraception Sterilization Use Among Married Men in the United States" /> Men with less education were more likely to report female sterilization in their partner.<ref name="Contraception Sterilization Use Among Married Men in the United States" /> In contrast to female sterilization trends, vasectomy was associated with white males and those who had ever visited a [[family planning]] clinic.<ref name="Contraception Sterilization Use Among Married Men in the United States">Anderson, John E. et al. 2010. "Contraceptive Sterilization Use Among Married Men in the United States: Results from the Male Sample of the National Survey of Family Growth". 82(3): 230–235</ref>

Several factors can explain the different findings between female and male sterilization trends in the [[United States]]. Women are more likely to receive reproductive health services. "Additionally, overall use of contraception is associated with higher socioeconomic status, but for women, use of contraceptive tubal sterilization has been found to be related to lower socioeconomic status and lack of health insurance." <ref name="Contraception Sterilization Use Among Married Men in the United States" /> This finding could be related to [[Medicaid]]-funded sterilizations in the [[postpartum period]] that are not available to men.<ref name="Contraception Sterilization Use Among Married Men in the United States" />