Iowa State student publishes research on female sterilization biases

Sara Davis
Sara Davis

Following two challenging pregnancies that made it hard for Sara Davis to eat solid food and resulted in emergency Caesarean sections — along with other complications — the 28-year-old mother of two and her husband in 2016 decided to get sterilized.

The couple’s initial inclination was for a vasectomy — the less expensive male version of the procedure. So her husband made a quick call, securing a consultation and operation for a single visit.

No questions asked, Davis said.

Before the procedure, though, he backed out, prompting Davis to take the lead on sterilization. And her experience investigating, scheduling and finally getting her tubes tied — so to speak — was quite different.

That divergence became the subject of one of Davis’ class projects in 2017 — when she was an Iowa State University undergrad taking a gender and communication course under associate professor of English Abby Dubisar. And it propelled her additional grant-funded research last summer — producing a study eventually published in the journal Rhetoric of Health and Medicine.

Q: Tell me how your sterilization experience differed from the one your husband had.

A: I expected to have a similar time in finding a doctor and getting it scheduled, but it turns out it was actually more difficult to find somebody willing to meet with me. When I did find a physician, they asked a lot of questions — like, “Are you sure this is what you want to do? Have you considered these alternative methods, like long-term birth control?”

It seemed like they didn’t really trust me to make that decision for myself.

Q: How insistent did you have to be to get the procedure done?

A: I brought my husband to the initial consultation, and it wasn’t until he said, “This is what she wants” that the doctor stopped offering me alternatives.

Q: How did the operation go?

A: When I got there and they were prepping me for surgery, checking my ID, the doctor came in and asked me again, “Are you sure this is what you want to do?” There was a lot of questioning and offering of alternatives, whereas when my husband called to schedule his appointment, they would have done the consultation and the vasectomy on the same day. It was eye-opening.

Q: How did your experience propel your subsequent research?

A: My goal was to find out why there seems to be this discrepancy between the way women are counseled and the way men are counseled. So first I looked into the information that doctors will give patients. And the first thing I noticed was the difference between the two pamphlets — the one that my husband received and the one that I received.

On the vasectomy pamphlet, there was a very happy heterosexual couple with children looking like they were very comfortable and very happy with their decision. But on the women’s pamphlet, it showed a woman who seemed to be very pensive, uncomfortable, her hands were crossed in front of her face.

Right away it was communicating that, maybe this is not the best decision for a woman and it requires a bit more thought.

Q: How did you gauge the broader public experience — to determine yours wasn’t the exception?

A: I looked at Twitter and Reddit, I looked at a lot of blogs and articles like in the New York Times and The Atlantic and the Chicago Times, just to see what women were talking about when it comes to personal experiences. A lot of women had a similar experience.”

Q: And so how did you answer the why — in terms of divergent treatment?

A: The why was more complicated. I looked into the rhetorical differences when we’re communicating ideas to men and communicating ideas to women. We also looked into the cult of motherhood and the patriarchal ideas that women’s best occupation is motherhood and that women in general want to have children.

That ideology follows into the clinic, and a lot of doctors have that similar idea that they have to safeguard their patients against making a decision that might lead them to feeling unfulfilled.

Q: Could it be that female sterilization procedures are just more risky and invasive than the male procedures?

A: Yes, there are more risks because the procedure for a female is more invasive.


But women also undergo other procedures that are cosmetic that are much more invasive than a tubal ligation — such as a breast augmentation — and you don’t see doctors counseling against a breast augmentation because that’s something that’s socially acceptable.

Q: Did you interview doctors about why the different treatment for men and women seeking sterilization?

A: Different privacy concerns and requirements prevented interviews for the research, she said. “We did rely on secondhand information and our own personal experience in speaking with physicians.”

Q: What would you like to see come from your findings?

A: The biggest thing would be for doctors who perform sterilization procedures to just be aware of some of the biases that are present within the physician-patient discourse, and they shouldn’t be functioning as counselors guarding against hypothetical future feelings of regret.

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