Young, Childfree Women and Surgical Sterilisation: The Paradox of Law and Society

This PhD project focuses on the experiences that young, childfree women face when they seek surgical sterilisation in England and Wales. The project combines doctrinal, bioethical and qualitative research to analyse women's rights to sterilisation and experiences requesting the procedure. The right to sterilisation will be discussed with reference to the National Health Service (Family Planning) Amendment Act 1972, NHS guidance and international conventions that protect a woman's right to reproductive freedom. Still, sterilisation requests are party to a paradoxical healthcare culture that undermines women's reproductive choice in consideration of hypothetical outcomes. Young, childfree women are often denied the procedure in their 'best interests', as they may eventually decide that they want children and regret their decision to be sterilised. The project utilises Feminist theory, Law-and-Emotion scholarship and Medico-ethical principles under a conceptual framework to analyse the presence of pronatalism, paternalism and concerns of regret in discourse with physicians. Pronatalist culture is a core focus of this project, which analyses the strong emphasis placed on women fulfilling their obligation of motherhood. Furthermore, the potential for regret is a strong concern of physicians when women seek sterilisation. This project explores the role of emotion in medico-legal decision-making to analyse whether regret should be dominant in healthcare discourse. A woman's younger age can also cause concern when requesting sterilisation. Physicians often reinforce the stereotype that wisdom accompanies older age, whereas it is debatable whether age necessarily correlates with better decision-making. As a result of age and childfree status, young women are often told to request sterilisation again when they are older, have had children, or, if single, when they have found a partner and have re-evaluated their situation. Such standards are most prevalent in procedures that remove one's fertility; seeking Assisted Reproductive Technologies such as IVF, or deciding to have cosmetic surgery are both not party to anxieties from physicians about regret or one's age. The treatment of young, childfree women seeking sterilisation is underreported in academic literature and is woefully neglected in empirical research. Therefore, this thesis also includes a qualitative strand, conducting semi-structured interviews with young, childfree women. It intends to gain an original and deep understanding of women's first-hand experiences with seeking sterilisation; it also has the potential to uncover themes from participants' responses that have not yet been apportioned academic attention. Although physicians may deny sterilisation to prevent long-term harm to the patient by avoiding regret, disappointment, and other accompanying 'negative' emotions from remaining childfree, the impact on women who are refused sterilisation is significant. Conducting this project will allow for an in-depth analysis of the impact that sterilisation refusals have had on women. The thesis concludes that denying sterilisation undermines reproductive autonomy and simultaneously represents a concerning rise in paternalistic healthcare practices. The project proposes clearer regulatory guidance concerning surgical sterilisation and specific training for healthcare professionals on how to handle requests for treatment that they believe may be regrettable or ill-advised.