On female sterilization.

Tubals. Vag hysts. Abdo hysts. I have scrubbed into more of these surgeries than I ever really expected to. I suppose that in the US I saw a lot of sterilizations , but it seems like every other woman I meet at the hospital here is tired of having children. And when you hear the birth histories, it makes sense. It is not uncommon for women to have 6-10 pregnancies with 4-8 live children. The questions go something like this:

How many pregnancies have you had?
How many of those died while you were pregnant?
How many died after?

The assumption of not only pregnancy losses but also of the loss of children is rarely found to be false. I’ve seen women in the US burst into tears when relating their pregnancy losses. Here, that doesn’t happen. It isn’t that women don’t cherish their children and mourn their deaths, but rather (I think) that loss is so common, it is simply an expected part of life.

Women have a lot of children here. They get married young, and they seem to keep having babies until they can’t have them any more. In a part of the world where being pregnant is a real threat to the health of a woman, it is no surprise that women recognize that being safe from pregnancy is a real benefit.

Last week we did a post-partum tubal ligation on a 25-year-old women. In the US this would be considered to be very young – in many hospitals it would go before the ethics committee before it could be approved. In Massachusetts, if you want a sterilization preformed you have to sign a form at least 30 days before the procedure – just so you can be sure that it isn’t a pressured decision. Here, it is a different story. When the doc asks them if they want more children, the discussion often takes place hours before the procedure. If you waited 30 days here, it would never happen. Plus, at 27 this woman had already had 6 pregnancies, with 5 living children.

The most common reason for desiring sterilization I’ve heard women express: I’m tired. I take this to mean not only I’m tired of having babies wake me up at all hours of the night, and I’m tired of school fees, and teenager drama, but also I’m tired of being pregnant, I am exhausted by the risks of pregnancy, by the knowledge that every time I get pregnant I take my life in my hands.

I had an attending in the US who told me more than once that the fetus will steal all the energy and nutrients that it needs from mom, no matter how depleted this leaves her. (a great argument for birth spacing – mom needs the time to build up her energy stores before baby steals them again) You see this depletion in the women here. They endure pregnancy after pregnancy, often with no break in between. They are worn down; they are thin. They are tired.

Never when I was scrubbed into a tubal in the states did I feel like the procedure might save the woman’s life simply by virtue of preventing pregnancy. Here, I feel that way every time.