불임 시술에 대한 접근성을 둘러싼 여성의 투쟁이 의문을 제기하다

Critics say women face unequal treatment but others say tighter controls reflect legitimate medical concernsA psychologist who was denied sterilisation on the NHS has successfully challenged the decision after taking her case to the health ombudsman, raising questions over how accessible the procedure should be.Leah Spasova spent years seeking an operation to prevent pregnancy by blocking the fallopian tubes. Many argue that barriers faced by women, from funding refusals to stricter eligibility criteria, amount to unequal treatment compared with men seeking vasectomies, and limit bodily autonomy.

A psychologist who was denied sterilisation on the NHS has successfully challenged the decision after taking her case to the health ombudsman, raising questions over how accessible the procedure should be.

Leah Spasova spent years seeking an operation to prevent pregnancy by blocking the fallopian tubes. Many argue that barriers faced by women, from funding refusals to stricter eligibility criteria, amount to unequal treatment compared with men seeking vasectomies, and limit bodily autonomy.

However, others say tighter controls reflect legitimate medical concerns, including the procedure’s relative risk, its permanence, and evidence that some patients later regret the decision.

In 2024-25, 10,793 female sterilisations were carried out, down 22% on a decade ago, while there were 26,385 vasectomies, up 16% year on year.

Charlotte Glynn, a research and innovation nurse at the British Pregnancy Advisory Service, said: “Working in abortion care, we see many women who have been placed on waiting lists for sterilisation or have requested it but been told they are too young. There is a real problem with women not being trusted to make decisions about their own bodies.”

She added: “There is an argument that it is a riskier procedure than a vasectomy, but if a woman is given the right information to make an informed decision and that is what she wants, that should be respected. In terms of cost, multiple unintended pregnancies also carry a cost. Many women struggle with the side-effects of contraceptive pills and patches.”

Glynn said men were not questioned in the same way when requesting sterilisation. “It is a form of medical misogyny,” she said. “Women are often seen as primarily defined by childbearing and reproduction.”

She described access as a “postcode lottery” and said the procedure was not always treated as essential, meaning women rarely reached the top of waiting lists. “We had one patient who had asked her GP for a sterilisation referral three times. She already had two or three children but was under 30, so was told she was too young. She later became pregnant and had an abortion. Some women feel more empowered after that experience to go back and insist they do not want more children.”

Glynn concluded: “We should be making sterilisation more accessible. Like many areas of women’s health, this needs improvement.”

However, Anna Glasier, an emeritus professor at the University of Edinburgh, said women did have the same access as men. She argued: “The issues with the procedure being effectively irreversible are the same for both men and women and there are long waiting times for vasectomy throughout the UK.

“For women, long-acting reversible contraception provides a method of fertility regulation which is as effective as sterilisation, and will work for 8-12 years, – but which is instantly reversible. So for women there is a good alternative and it makes sense to offer it to them, while for men the only other methods are condoms or withdrawal.”

She concluded: “It’s challenging because many of the women requesting sterilisation are relatively young, and we know there is a measurable rate of regret. Some studies suggest it could be as high as 20%, or one in five. The data also shows that regret is more likely in younger patients, and particularly when sterilisation is carried out soon after a pregnancy – for example, within a year of having a baby.

“That’s one reason why long-acting reversible contraception – like the IUD, hormonal coil or implant – is often encouraged, as it keeps options open.”