human sterilization (surgical procedure)
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Sterilization ( also spelled sterilisation) is any of a number of medical methods of
birth control Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy Pregnancy is the time during which one or more offspring develops (gestation, gestates) i ...
that intentionally leaves a person unable to reproduce. Sterilization methods include both surgical and non-surgical, and exist for both males and females. Sterilization procedures are intended to be permanent; reversal is generally difficult or impossible. There are multiple ways of having sterilization done, but the two that are used most frequently are tubal ligation for women and vasectomy for men. There are many different ways tubal sterilization can be accomplished. It is extremely effective and in the United States surgical complications are low. With that being said, tubal sterilization is still a method that involves surgery, so there is still a danger. Women that chose a tubal sterilization may have a higher risk of serious side effects, more than a man has with a vasectomy. Pregnancies after a tubal sterilization can still occur, even many years after the procedure. It is not very likely, but if it does happen there is a high risk of ectopic gestation. Statistics confirm that a handful of tubal sterilization surgeries are performed shortly after a vaginal delivery mostly by minilaparotomy. In some cases, sterilization can be reversed but not all. It can vary by the type of sterilization performed.


Methods


Surgical

Surgical sterilization methods include: * Tubal ligation in females, known popularly as "having one's tubes tied". The
fallopian tube The fallopian tubes, also known as uterine tubes, oviducts or salpinges (singular salpinx), are paired tubes in the human female that stretch from the uterus to the Ovary, ovaries. The fallopian tubes are part of the female reproductive system ...
s, which allow the sperm to fertilize the
ovum The egg cell, or ovum (plural ova), is the female Reproduction, reproductive cell, or gamete, in most anisogamous organisms (organisms that reproduce sexually with a larger, female gamete and a smaller, male one). The term is used when the fema ...
and would carry the fertilized ovum to the
uterus The uterus (from Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around p ...
, are closed. This generally involves a general anesthetic and a laparotomy or laparoscopic approach to cut, clip or cauterize the fallopian tubes. * Bilateral salpingectomy in females, also known as tubal removal. Both fallopian tubes are surgically removed. When done for contraceptive purposes, the ovaries are left in place. This method is considered more effective than tubal ligation, as there is no chance of tubal reconnection or clip failure, and also prevents cancer of the fallopian tubes and can reduce risk of ovarian cancer. * Vasoligation in males. The vasa deferentia, the tubes that connect the
testicle A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is Homology (biology), homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, pr ...
s to the
prostate The prostate is both an Male accessory gland, accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, ...
, are cut and closed. This prevents
sperm Sperm is the male reproductive Cell (biology), cell, or gamete, in anisogamous forms of sexual reproduction (forms in which there is a larger, female reproductive cell and a smaller, male one). Animals produce motile sperm with a tail known as ...
produced in the testicles from entering the ejaculated
semen Semen, also known as seminal fluid, is an organic bodily fluid created to contain spermatozoon, spermatozoa. It is secreted by the gonads (sexual glands) and other sexual organs of male or hermaphrodite, hermaphroditic animals and can fertili ...
(which is mostly produced in the seminal vesicles and
prostate The prostate is both an Male accessory gland, accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found only in some mammals. It differs between species anatomically, ...
). Although the term ''vasectomy'' is established in the general community, the correct
medical terminology Medical terminology is a language used to precisely describe the human body including all its components, processes, conditions affecting it, and procedures performed upon it. Medical terminology is used in the field of medicine Medicine is t ...
is vasoligation. *
Hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovary, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Usually performed by a gynaecology, gynecologist, a ...
in females. The
uterus The uterus (from Latin Latin (, or , ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around p ...
is surgically removed, permanently preventing
pregnancy Pregnancy is the time during which one or more offspring develops (gestation, gestates) inside a woman, woman's uterus (womb). A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occur ...
and some
disease A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medica ...
s, such as uterine cancer. *
Castration Castration is any action, surgical, chemical, or otherwise, by which an individual loses use of the testicles: the male gonad. Surgical castration is bilateral orchiectomy (excision of both testicles), while chemical castration uses phar ...
in males. The testicles are surgically removed. This is frequently used for the sterilization of animals, but rarely for humans. It was also formerly used on some human male children for other reasons; see
castrato A castrato (Italian, plural: ''castrati'') is a voice type, type of classical music, classical male singing human voice, voice equivalent to that of a soprano, mezzo-soprano, or contralto. The voice is produced by castration of the singer before ...
and
eunuch A eunuch ( ) is a male who has been castration, castrated. Throughout history, castration often served a specific social function. The earliest records for intentional castration to produce eunuchs are from the Sumerian city of Lagash in the 2n ...
.


Transluminal

Transluminal procedures are performed by entry through the female reproductive tract. These generally use a catheter to place a substance into the
fallopian tube The fallopian tubes, also known as uterine tubes, oviducts or salpinges (singular salpinx), are paired tubes in the human female that stretch from the uterus to the Ovary, ovaries. The fallopian tubes are part of the female reproductive system ...
s that eventually causes blockage of the tract in this segment. Such procedures are generally called ''non-surgical'' as they use natural orifices and thereby do not necessitate any surgical incision. *The Essure procedure was one such transluminal sterilization technique. In this procedure,
polyethylene terephthalate Polyethylene terephthalate (or poly(ethylene terephthalate), PET, PETE, or the obsolete PETP or PET-P), is the most common thermoplastic polymer resin of the polyester family and is used in synthetic fibre, fibres for clothing, packaging, conta ...
fiber inserts were placed into the fallopian tubes, eventually inducing scarring and occlusion of the tubes. In April 2018, the FDA restricted the sale and use of Essure. On July 20, 2018, Bayer announced the halt of sales in the US by the end of 2018. * Quinacrine has also been used for transluminal sterilization, but despite a multitude of clinical studies on the use of quinacrine and female sterilization, no randomized, controlled trials have been reported to date and there is some controversy over its use.Drugs.com --> Quinacrine.
Retrieved on August 24, 2009
See also mepacrine.


Pharmacological

There is no working "sterilization pill" that causes permanent inability to reproduce. In the 1977 textbook ''Ecoscience: Population, Resources, Environment'', on page 787, the authors speculate about future possible oral sterilants for humans. In 2015, DNA editing using gene drives to sterilize mosquitos was demonstrated. There have been hoaxes involving fictitious drugs that would purportedly have such effects, notably progesterex. See also Norplant,
Depo-Provera Medroxyprogesterone acetate (MPA), also known as depot medroxyprogesterone acetate (DMPA) in injectable form and sold under the brand name Depo-Provera among others, is a hormonal medication of the progestin type. It is used as a method of b ...
and oral contraceptive.


Voluntary 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. However, better access to
contraception Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
, 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 choose to be childless.Forsyth, Craig J. 1999. "The Perspectives of Childless Couples". ''International Review of Modern Sociology''. 29(2): 59–70. 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."Kelly, Maura. 2009. "Women's Voluntary Childlessness: A Radical Rejection of Motherhood?". ''Women's Studies Quarterly''. 37(3/4): 157–172. In industrialized countries such as the United Kingdom, those of Western Europe, and the United States, the
fertility rate The total fertility rate (TFR) of a population is the average number of children that would be born to a woman over her lifetime if: # she were to experience the exact current age-specific fertility rates (ASFRs) through her lifetime # she were t ...
has declined below or near the population
replacement rate The total fertility rate (TFR) of a population is the average number of children that would be born to a woman over her lifetime if: # she were to experience the exact current age-specific fertility rates (ASFRs) through her lifetime # she were t ...
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.Gillespie, Rosemary. 2003. "Childfree and Feminine: Understanding the Gender Identity of Voluntary Childless Women". ''Gender and Society''. 17(1): 122–136. According to the 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 1976.2010. "Fertility of American Women: 2008". American Community Survey. United States' Census Bureau. 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. 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. 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." '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. With regard to 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 why they remained
childfree Voluntary childlessness, also called being childfree, describes the voluntary choice childlessness, to not have children. In most societies and for most of human history, choosing not to have children was both difficult and undesirable. The avail ...
. Combined with the costliness of raising children, having children was viewed as a negative impact on financial resources. 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. In these finding, 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 come from a variety of federal and state sources in the United States. Until the mid-1990s, " deral funds for contraceptive services ereprovided under Title X of the Public Health Service Act, Title XIX of the
Social Security Welfare, or commonly social welfare, is a type of government support intended to ensure that members of a society can meet Basic needs, basic human needs such as food and shelter. Social security may either be synonymous with welfare, or refe ...
(Medicaid), and two block-grant programs, Maternal and Child Health (MCH) and Social Services."Gold, Rachel Benson and Barry Nestor. 1985. "Public Funding of Contraceptive, Sterilization, and Abortion Services". ''Family Planning Perspectives''. 17(1): 25–30. 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 The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto ...
administers Title X, which is 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 Medicaid in the United States is a federal and state program that helps with Health care, healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare (United States), Medicare ...
is an entitlement program that is jointly funded by federal and state governments to "provide medical care to various low-income populations."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. Medicaid provided the majority of publicly funded sterilizations. In 1979, regulations were implemented on sterilizations funded by the 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."


Physiological

Physiological reasons, such as genetic disorders or disabilities, can influence whether couples seek sterilization. According to the Centers for Disease Control and Prevention, about 1 in 6 children in the U.S. had a
developmental disability Developmental disability is a diverse group of chronic conditions, comprising mental or physical impairments that arise before adulthood. Developmental disabilities cause individuals living with them many difficulties in certain areas of life, espe ...
in 2006–2008."Developmental Disabilities Increasing in US". Centers for Disease Control and Prevention. 2011. Developmental disabilities are defined as "a diverse group of severe chronic conditions that are due to mental and/or physical impairments." Many disabled children may eventually grow to lead independent lives as adults, but they may require intensive parental care and extensive medical costs as children. Intensive care can lead to a parent's "withdrawal from the labor force, worsened economic situation of the household, interruptions in parents' sleep and a greater chance of marital instability."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. Couples may choose sterilization in order to concentrate on caring for a child with a disability and to avoid withholding any necessary resources from additional children. Alternatively, couples may also desire more children in hopes of experiencing the normal parental activities of their peers. A child without a disability may be more likely to provide the couple with grandchildren and support in their old age. For couples without children, technological advancements have enabled the use of carrier screening and
prenatal testing Prenatal testing consists of prenatal screening and prenatal diagnosis, which are aspects of prenatal care that focus on detecting problems with the pregnancy as early as possible. These may be anatomy, anatomic and physiology, physiologic proble ...
for the detection of genetic disorders in prospective parents or in their unborn offspring.Rowley, Peter T. "Genetic Screening: Marvel or Menace?". 1984. ''Science''. 225(4658): 138–144. 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.


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 The Centers for Disease Control and Prevention (CDC) is the National public health institutes, national public health agency of the United States. It is a Federal agencies of the United States, United States federal agency, under the United S ...
, 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.2010. "Use of Contraception in the United States: 1982–2008". ''Vital and Health Statistics''. 23(29) Minority women were more likely to use female sterilization than their white counterparts.Zite, Nikki and Sonya Borrero. 2011. "Female Sterilisation in the United States". ''The European Journal of Contraception and Reproductive Health Care''. 16: 336–340. The proportion of women using female sterilization was highest for black women (22%), followed by Hispanic women (20%) and white women (15%). 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. 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. 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. 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, " ss-educated women aged 22–44 years were much more likely to rely on female sterilization than those with more education." 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. Because national surveys of 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. Men with less education were more likely to report female sterilization in their partner. In contrast to female sterilization trends, vasectomy was associated with white males and those who had ever visited a
family planning Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marita ...
clinic.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 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." This finding could be related to
Medicaid Medicaid in the United States is a federal and state program that helps with Health care, healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare (United States), Medicare ...
-funded sterilizations in the postpartum period that are not available to men.


Promoted sterilization


Compulsory

Compulsory sterilization refers to governmental policies put in place as part of human population planning or as a form of
eugenics Eugenics ( ; ) is a Fringe science, fringe set of beliefs and practices that aim to improve the genetics, genetic quality of a human population. Historically, eugenicists have attempted to alter human gene pools by excluding people and groups ...
(changing hereditary qualities of a race or breed by controlling mating) to prevent certain groups of people from reproducing. An example of forced sterilization that was ended within the last two decades is Japan's Race Eugenic Protection Law, which required citizens with mental disorders to be sterilized. This policy was active from 1940 until 1996, when it and all other eugenic policies in Japan were abolished.Matsubara, Yôko. "The Enactment of Japan's Sterilization Laws in the 1940s: A Prelude to Postwar Eugenic Policy." ''The History of Science Society of Japan''. 8.2 (1998): 187–201. In many cases, sterilization policies were not explicitly compulsory in that they required consent. However, this meant that men and women were often coerced into agreeing to the procedure without being of a right state of mind or receiving all of the necessary information. Under the Japanese
leprosy Leprosy, also known as Hansen's disease (HD), is a Chronic condition, long-term infection by the bacteria ''Mycobacterium leprae'' or ''Mycobacterium lepromatosis''. Infection can lead to damage of the Peripheral nervous system, nerves, respira ...
policies, citizens with leprosy were not forced into being sterilized; however, they had been placed involuntarily into segregated and quarantined communities. In America, some women were sterilized without their consent, later resulting in lawsuits against the doctors who performed those surgeries. There are also many examples of women being asked for their consent to the procedure during times of high stress and physical pain. Some examples include women who have just given birth and are still being affected by the drugs, women in the middle of labor, or people who do not understand English. Many of the women affected by this were poor, minority women.Pierson-Balik, Denise A. 2003. "Race, Class, and Gender in Punitive Welfare Reform: Social Eugenics and Welfare Policy". ''Race, Gender, & Class''. 10 (1): 11–30. In May 2014, the
World Health Organization The World Health Organization (WHO) is a list of specialized agencies of the United Nations, specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainme ...
, OHCHR,
UN Women The United Nations Entity for Gender Equality and the Empowerment of Women, also known as UN Women, is a United Nations The United Nations (UN) is an intergovernmental organization whose stated purposes are to maintain international peace ...
, UNAIDS,
UNDP The United Nations Development Programme (UNDP)french: Programme des Nations unies pour le développement, PNUD is a United Nations agency tasked with helping countries Poverty reduction, eliminate poverty and achieve Sustainable development, ...
, UNFPA and
UNICEF UNICEF (), originally called the United Nations International Children's Emergency Fund in full, now officially United Nations Children's Fund, is an agency of the United Nations responsible for providing Humanitarianism, humanitarian and Devel ...
issued a joint statement on Eliminating forced, coercive and otherwise involuntary sterilization, An interagency statement. The report references the involuntary sterilization of a number of specific population groups. They include: *
women A woman is an adult female human. Prior to adulthood, a female human is referred to as a girl (a female child or Adolescence, adolescent). The plural ''women'' is sometimes used in certain phrases such as "women's rights" to denote female hum ...
, especially in relation to coercive population control policies, and particularly including women living with
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause AIDS, acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the ...
, indigenous and ethnic minority girls and women. Indigenous and ethnic minority women often face "wrongful stereotyping based on gender, race and ethnicity". *
people with disabilities Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be Cognitive disability, cognitive, Developmental disability, dev ...
, often perceived as sexually inactive. women with intellectual disabilities are "often treated as if they have no control, or should have no control, over their sexual and reproductive choices". Other rationales include menstrual management for the benefit of careers. *
intersex Intersex people are individuals born with any of several Sexual characteristics, sex characteristics including chromosome patterns, gonads, or sex organ, genitals that, according to the Office of the United Nations High Commissioner for Hum ...
persons, who "are often subjected to cosmetic and other non-medically indicated surgeries performed on their reproductive organs, without their informed consent or that of their parents, and without taking into consideration the views of the children involved", often as a "sex-normalizing" treatment. *
transgender A transgender (often abbreviated as trans) person is someone whose gender identity or gender expression does not correspond with their sex assignment, sex assigned at birth. Many transgender people experience gender dysphoria, dysphoria, which ...
persons, "as a prerequisite to receiving gender-affirmative treatment and gender-marker changes". The report recommends a range of guiding principles for medical treatment, including ensuring patient autonomy in decision-making, ensuring non-discrimination, accountability and access to remedies.


Incentivizing

Some governments in the world have offered and continue to offer economic incentives to using
birth control Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy Pregnancy is the time during which one or more offspring develops (gestation, gestates) i ...
, including sterilization. For countries with high population growth and not enough resources to sustain a large population, these incentives become more enticing. Many of these policies are aimed at certain target groups, often disadvantaged and young women (especially in the United States).Mauldon, Jane Gilbert. "Providing Subsidies and Incentives for Norplant, Sterilization and Other Contraception: Allowing Economic Theory to Inform Ethical Analysis." ''The Journal of Law, Medicine & Ethics''. 31.3 (2003): 351–64. While these policies are controversial, the ultimate goal is to promote greater social well-being for the whole community. One of the theories supporting incentivizing or subsidy programs in the United States is that it offers
contraception Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
to citizens who may not be able to afford it. This can help families prevent unwanted pregnancies and avoid the financial, familial, and personal stresses of having children if they so desire. Sterilization becomes controversial in the question of the degree of a government's involvement in personal decisions. For instance, some have posited that by offering incentives to receive sterilization, the government may change the decision of the families, rather than just supporting a decision they had already made. Many people agree that incentive programs are inherently coercive, making them unethical. Others argue that as long as potential users of these programs are well-educated about the procedure, taught about alternative methods of contraception, and are able to make voluntary, informed consent, then incentive programs are providing a good service that is available for people to take advantage of.


National examples


Singapore

Singapore Singapore (), officially the Republic of Singapore, is a sovereign island country, island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Pen ...
is an example of a country with a sterilization incentive program. In the 1980s, Singapore offered US$5000 to women who elected to be sterilized. The conditions associated with receiving this grant were fairly obvious in their aim at targeting low income and less educated parents. It specified that both parents should be below a specified educational level and that their combined income should not exceed $750 per month. This program, among other birth control incentives and education programs, greatly reduced Singapore's birth rate, female mortality rate, and infant mortality rate, while increasing family income, female participation in the labor force, and rise in educational attainment among other social benefits. These are the intended results of most incentivizing programs, although questions of their ethicality remain.


India

Another country with an overpopulation problem is
India India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area, the List of countries and dependencies by population, second-most populous ...
. Medical advances in the past fifty years have lowered the death rate, resulting in large population density and overcrowding. This overcrowding is also due to the fact that poor families do not have access to
birth control Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy Pregnancy is the time during which one or more offspring develops (gestation, gestates) i ...
. Despite this lack of access, sterilization incentives have been in place since the mid-1900s. In the 1960s, the governments of three Indian states and one large private company offered free vasectomies to some employees, occasionally accompanied by a bonus. In 1959, the second Five-Year Plan offered medical practitioners who performed vasectomies on low-income men monetary compensation. Additionally, those who motivated men to receive vasectomies, and those men who did, received compensation. These incentives partially served as a way to educate men that sterilization was the most effective way of contraception and that vasectomies did not affect sexual performance. The incentives were only available to low income men. Men were the target of sterilization because of the ease and quickness of the procedure, as compared to sterilization of women. However, mass sterilization efforts resulted in lack of cleanliness and careful technique, potentially resulting in botched surgeries and other complications. As the fertility rate began to decrease (but not quickly enough), more incentives were offered, such as land and fertilizer. In 1976, compulsory sterilization policies were put in place and some disincentive programs were created to encourage more people to become sterilized. However, these disincentive policies, along with "sterilization camps" (where large amounts of sterilizations were performed quickly and often unsafely), were not received well by the population and gave people less incentive to participate in sterilization. The compulsory laws were removed. Further problems arose and by 1981, there was a noticeable problem in the preference for sons. Since families were encouraged to keep the number of children to a minimum, son preference meant that female fetuses or young girls were killed at a rapid rate. The focus of population policies has changed in the twenty-first century. The government is more concerned with empowering women, protecting them from violence, and providing basic necessities to families. Sterilization efforts are still in existence and still target poor families.


China

When the
People's Republic of China China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's List of countries and dependencies by population, most populous country, with a Population of China, population exceeding 1.4 billion, slig ...
came to power in 1949, the Chinese government viewed population growth as a growth in development and progress. The population at the time was around 540 million. Therefore,
abortion Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregnan ...
and sterilization were restricted. With these policies and the social and economic improvements associated with the new regime, a rapid population growth ensued. By the end of the
Cultural Revolution The Cultural Revolution, formally known as the Great Proletarian Cultural Revolution, was a sociopolitical movement in the People's Republic of China (PRC) launched by Mao Zedong in 1966, and lasting until Death and state funeral of Mao Zedon ...
in 1971 and with a population of 850 million, population control became a top priority of the government. Within six years, more than thirty million sterilizations were performed on men and women. Soon the well-known
one-child policy The term one-child policy () refers to a Human population planning, population planning initiative in China implemented between 1980 and 2015 to curb Demographics of China#Population, the country's population growth by restricting many familie ...
was enforced, which came along with many incentives for parents to maintain a one-child family. This included free books, materials, and food for the child through primary school if both parents agreed to sterilization. The policy also came along with harsh consequences for not adhering to the one-child limit. For example, in Shanghai, parents with "extra children" must pay between three and six times the city's average yearly income in "social maintenance fees." In the past decade, the restrictions on family size and reproduction have lessened. The Chinese government has found that by giving incentives and disincentives that are more far-reaching than a one-time incentive to be sterilized, families are more willing to practice better family planning. These policies seem to be less coercive as well, as families are better able to see the long-term effects of their sterilization rather than being tempted with a one-time sum.


Criminalization


Poland

In Poland, reproductive sterilisation of men or women has been defined as a criminal act since 1997 and remains so , under Article 156 §1, which also covers making someone blind, deaf or mute, of the 1997 law. The original 1997 law punished contraventions with a prison sentence of one to ten years and the updated law sets a prison sentence of at least 3 years. The prison sentence is a maximum of three years if the sterilisation is involuntary, under Art. 156 §2.


Effects

The effects of sterilization vary greatly according to gender, age, location, and other factors. When discussing female sterilization, one of the most important factors to consider is the degree of power that women hold in the household and within society.


Physical

Understanding the physical effects of sterilization is important because it is a common method of contraception. Among women who had interval tubal sterilization, studies have shown a null or positive effect on female sexual interest and pleasure.Costello, Caroline et al. 2002. "The Effect of Interval Tubal Sterilization on Sexual Interest and Pleasure". ''The American College of Obstetricians and Gynecologists''. 100(3): 511–517. Similar results were discovered for men who had vasectomies. Vasectomies did not negatively influence the satisfaction of men and there was no significant change in communication and marital satisfaction among couples as a result.Hofmeyr, Doreen G. and Abraham P. Greeff. 2002. "The Influence of a Vasectomy on the Marital Relationship and Sexual Satisfaction of the Married Man". ''Journal of Sex and Marital Therapy''. 28:339–351. According to ''Johns Hopkins Medicine'', tubal sterilizations result in serious problems in less than 1 out of 1000 women. Tubal sterilization is an effective procedure, but pregnancy can still occur in about 1 out of 200 women. Some potential risks of tubal sterilization include "bleeding from a skin incision or inside the abdomen, infection, damage to other organs inside the abdomen, side effects from anesthesia, ectopic pregnancy (an egg that becomes fertilized outside the uterus), ndincomplete closing of a fallopian tube that results in pregnancy.""Tubal Ligation". Johns Hopkins Medicine. Potential risks of vasectomies include "pain continuing long after surgery, bleeding and bruising, a (usually mild) inflammatory reaction to sperm that spill during surgery called sperm granuloma, ndinfection." Additionally, the
vas deferens The vas deferens or ductus deferens is part of the male reproductive system of many vertebrates. The ducts transport sperm from the epididymis to the ejaculatory ducts in anticipation of ejaculation. The vas deferens is a partially coiled tube w ...
, the part of the male anatomy that transports sperm, may grow back together, which could result in unintended pregnancy."Vasectomy". Johns Hopkins Medicine.


Psychological

It can be difficult to measure the psychological effects of sterilization, as certain psychological phenomenon may be more prevalent in those who eventually decide to partake in sterilization. The relationships between psychological problems and sterilization may be due more to
correlation In statistics, correlation or dependence is any statistical relationship, whether causality, causal or not, between two random variables or bivariate data. Although in the broadest sense, "correlation" may indicate any type of association, in ...
rather than causation. That being said, there are several trends surrounding the psychological health of those who have received sterilizations. A 1996 Chinese study found that "risk for depression was 2.34 times greater after tubal ligation, and 3.97 times greater after vasectomy." If an individual goes into the procedure after being coerced or with a lack of understanding of the procedure and its consequences, they are more likely to develop negative psychological consequences afterwards. However, most people in the United States who are sterilized maintain the same level of psychological health as they did prior to the procedure. Because sterilization is a largely irreversible procedure, post-sterilization regret is a major psychological effect. The most common reason for post-sterilization regret is the desire to have more children.


Familial


Women in the household

Some people believe that sterilization gives women, in particular, more control over their
sexuality Human sexuality is the way people experience and express themselves Human sexual activity, sexually. This involves biological, psychological, Physical intimacy, physical, erotic, Emotional intimacy, emotional, social, or Spirituality, spiritua ...
and their
reproduction Reproduction (or procreation or breeding) is the biological process by which new individual organisms – "offspring" – are produced from their "parent" or parents. Reproduction is a fundamental feature of all known life; each individual org ...
. This can lead to empowering women, to giving them more of a sense of ownership over their body, as well as to an improved relationship in the household.STOLC, Phyllis E W. "Seeking Zero Growth: Population Policy in China and India". ''Graduate Journal of Asia-Pacific Studies''. 6.2 (2008): 10–32. In the United States, where there are no governmental incentives for being sterilized (see below), the decision is often made for personal and familial reasons. A woman, sometimes along with her husband or partner, can decide that she does not want any more children or she does not want children at all. Many women report feeling more sexually liberated after being sterilized, as there is no concern of a pregnancy risk. By eliminating the risk of having more children, a woman can commit to a long-term job without a disruption of a
maternity leave Parental leave, or family leave, is an employee benefit available in almost all countries. The term "parental leave" may include maternity, Paternity (law), paternity, and adoption leave; or may be used distinctively from "maternity leave" and ...
in the future. A woman will feel more empowered since she could make a decision about her body and her life. Sterilization eliminates the need for potential abortions, which can be a very stressful decision overall.Abell, P. K. "The Decision to End Childbearing by Sterilization." ''Family Relations''. 36.1 (1987): 66–71.


Relationship with spouse

In countries that are more entrenched in the traditional patriarchal system, female sterilizations can inspire abusive behavior from husbands for various reasons.Rao, Vijayendra. "Wife-Beating in a Rural South India Community." ''Social Science and Medicine''. 44.8 (1997): 1169–1181. Sterilization can lead to distrust in a marriage if the husband then suspects his wife of infidelity. Furthermore, the husband may become angry and aggressive if the decision to be sterilized was made by the wife without consulting him. If a woman marries again after sterilization, her new husband might be displeased with her inability to bear him children, causing tumult in the marriage. There are many negative consequences associated with women who hold very little personal power. However, in more progressive cultures and in stable relationships, there are few changes observed in spousal relationships after sterilization. In these cultures, women hold more agency and men are less likely to dictate women's personal choices. Sexual activity remains fairly constant and marital relationships do not suffer, as long as the sterilization decision was made collaboratively between the two partners.


Children

As the Chinese government tried to communicate to their people after the population boom between 1953 and 1971, having fewer children allows more of a family's total resources to be dedicated to each child. Especially in countries that give parents incentives for family planning and for having fewer children, it is advantageous to existing children to be in smaller families. In more
rural In general, a rural area or a countryside is a geographic area that is located outside towns and city, cities. Typical rural areas have a low population density and small settlements. Agriculture, Agricultural areas and areas with forestry ty ...
areas where families depend on the labor of their children to survive, sterilization could have more of a negative effect. If a child dies, a family loses a worker. During China's controversial one-child policy reign, policymakers allowed families to have another child if an existing child in the same family died or became disabled. However, if either parent is sterilized, this is impossible. The loss of a child could impact the survival of an entire family.


Community and beyond

In countries with high population rates, such as China and India, compulsory sterilization policies or incentivizes to sterilization may be implemented in order to lower birth rates. While both countries are experiencing a decline in birth rate, there is worry that the rate was lowered too much and that there will not be enough people to fill the labor force. There is also the problem of son-preference: with greater sex selection technology, parents can abort a pregnancy if they know it is a female child. This leads to an uneven
sex ratio The sex ratio (or gender ratio) is usually defined as the ratio of males to females in a population. As explained by Fisher's principle, for evolutionary reasons this is typically about 1:1 in species which reproduce Sexual reproduction, sexually ...
, which can have negative implications down the line. However, experiencing a lower population rate is often very beneficial to countries. It can lead to lower levels of
poverty Poverty is the state of having few material possessions or little income. Poverty can have diverse social, economic, and political causes and effects. When evaluating poverty in ...
and
unemployment Unemployment, according to the OECD (Organisation for Economic Co-operation and Development), is people above a specified age (usually 15) not being in paid employment or self-employment but currently available for Work (human activity), w ...
.


See also

*
Infertility Infertility is the inability of a person, animal or plant to Sexual reproduction, reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). I ...
*
Eugenics Eugenics ( ; ) is a Fringe science, fringe set of beliefs and practices that aim to improve the genetics, genetic quality of a human population. Historically, eugenicists have attempted to alter human gene pools by excluding people and groups ...
* Male contraceptive * Vas-occlusive contraception


References


External links


Cat's sterilization (video)

Vasectomy Information
—The website of newsgroup alt.support.vasectomy.
All About Vasectomy & Finding a Doctor. Latest advances, videos etc

My Vasectomy in Words and Pictures
—One man's personal experience.
Vasectomy Reversal Resource

Female Sterilization Options
– /mk.nkl/cvas1.html Is Vasectomy the Right Method For Me?] and * *
Is Female Sterilization the Right Method For Me?Video: The NSV Procedure (graphic)
{{DEFAULTSORT:Sterilization (Surgical Procedure) Sterilization (medicine),