Health

Vasospasm is trending after the Roe v. Wade


For Trevor, a 35-year-old musician in Arizona, made the decision to have a vasectomy very easily. He and his wife have known for a long time that they don’t want to have children, so this procedure has always been on his mind.

But after learning about the leak of the US Supreme Court draft decision to overturn Roe v. Wade—Which could still change before it becomes final, possibly late June — “It’s like,“ Why am I procrastinating at this point? ”” Trevor said. “It’s such a big deal that I can take care of myself and my wife easily, so why not?” Trevor (who was asked to use only his first name to protect his privacy) is waiting to find out if state-provided insurance will cover the procedure, but said he will move forward shortly. even if you have to pay some expenses yourself.

Anecdotally, there are many reports of people looking at the same thing. Google searches for terms like “how much does a vasectomy cost” and “how to get a vasectomy” skyrocketed after Politico news about the May 2 leak, particularly in states where abortion practice is under attack, like Texas, Utah, and Missouri.

Search for “tubal ligation,” also known as tubal ligation or female sterilization, also increased significantly after the leak.

And social media is flooded with posts calling for men to have a vasectomy. “Men, It’s Time to Consider a Vasectomy”, read a recent article Slate title.

When performing surgery, vasectomy becomes simple. The doctor cuts or blocks the tubes through which the sperm travels, keeping the sperm from the semen and thus preventing pregnancy. Dr. Jonathan Clavell, a urologist in Houston, who has been tweets about his own recent vasectomy—And who says his patient coordinator has noticed more patients calling to inquire about the procedure in recent weeks.

Male and female sterilization has been used as a permanent, safe, effective method of contraception for decades. However, in the US, vasectomy was previously less common than female sterilization. In 2015, the United Nations estimated that about In the US, twice as many women are sterilized as men

Dr Ashley Winter, Oregon urologist, said: “I love the concept that a vasectomy will become popular. “But not for the reasons that have been and are happening.” She wishes people were looking for the procedure on their own terms — because she thinks it’s a great option for couples or individuals who don’t want or are about to have kids — rather than because of the limitations. possible for abortion and Other reproductive health care.

Winter is also concerned about misinformation spreading online. For example, some recent social media posts encouraged men to have vasectomy by emphasizing that they are easily reversible. While a vasectomy can be reversed, doing so requires a much more complex and invasive surgery than the original procedure; it is also not guaranteed to succeed. Winter tells her patients to think of a vasectomy like marriage: even though there’s still a way out, “you should plan for it to be permanent.”


Other social media posts suggest that men should have a vasectomy if access to abortion is limited. Such posts may seem like love language, but they take on a darker tone when considering the complicated history of permanent contraception in the United States. During the 1900s, It is not uncommon for doctors to sterilize both women and men (but often women) without consent or by force — especially those with disabilities and from disadvantaged backgrounds. poverty and lower socioeconomic classes. During the first half of the century, eugenics movement inspired more than half of US states to pass legislation specifically supporting this practice.

Historian Rebecca Kluchin, who has written a book on sterilization called “Due to its eugenic past, is often seen as a procedure for “unfit” women, especially women with disabilities. disability. Fit to be bound.

In 1976, in part to correct those atrocities, health authorities set new rules for women antiseptic procedure funded through Medicaid. Patients must be 21 years of age or older and are required to sign a consent form. They are also required to adhere to a mandatory waiting period (finally set to 30 days) from signing that consent form until proceeding with the activity.

Those regulations still exist today for people with public health insurance. Some doctors and patients argue that it creates an unnecessary barrier to care that mostly applies to lower-income, higher-risk patients. People who can’t take time off work or can’t afford to go to the medical office twice in 30 days may not get this procedure at all.

As it may well be, the policy “was born out of historical injustices against people from marginalized communities, who have been forced to sterilize against their will and are not allowed to live.” consent,” said Dr. Aishat Olatunde, a Pennsylvania-based ob-gyn and a member of the nonprofit group Reproductive Health Physicians. “This consent form is intended to protect those populations, but we found that it may limit access to permanent contraception.”

Even with consent standards in place, there are reports of blatant violations, such as when a nurse works in a U.S. Immigration and Customs Enforcement (ICE) facility because profit. say in 2020 that the doctors working there forcibly sterilized some individuals under the care of ICE. Dozens of women have corroborated that allegation, and the establishment has finally shut down last year by the Biden Administration.

Coercion persists in wiser ways. Some studies show that doctors are still more likely to recommend sterilization for disadvantaged people. From 2017-2019, nearly 40% of U.S. women without a high school diploma were sterilized, compared with 12% of those with a college diploma or higher. according to federal data. Women of color in the U.S. were twice as likely to be sterilized as white women (after controlling for age, insurance status, marital status, and parental status) while insured women Public health insurance or no insurance was about 1.4 times higher than women with private insurance, according to a 2017 report from the American College of Obstetricians and Gynecologists (ACOG).

“While they may reflect patient preferences, these differences raise concerns that women do not have equal access to the full range of reversible methods and that low-income women and Women of color may receive different contraceptive counseling than white women or women with private insurance,” the ACOG report said.


On the opposite end of the spectrum, some people who want to be sterilized face resistance from doctors who don’t want the procedure. Federal law allows health care providers to refuse to perform procedures that conflict with their religious beliefs, and 18 states have additional laws that allows some doctors to refuse to perform sterilization procedures.

Even in states that don’t have such laws, it’s not uncommon for patients to face resistance from doctors for fear they’ll regret the procedure later, often because of their youth or marital status.

Although there isn’t much research on this topic, anecdotal evidence suggests that young women are more likely to be denied sterilization than young men. Trevor, an Arizona man who plans to have a vasectomy, said his wife has been denied a tubal ligation five times, while he has had a hard time scheduling the procedure himself so far. The “Free for kids“The thread on Reddit is filled with stories from women struggling to be sterilized and some women said the doctor asked for their partner’s permission to go through sterilization, even in this day.

In a 2011 study, nearly 60% of American women surveyed said they would not encourage a 26-year-old woman to have a tubal ligation if her husband disagreed with her decision, and 32% said they would not. a 26-year-old patient even though her husband was on board. For a hypothetical 36-year-old patient, these rates drop to 47% and 10%. Providers’ thinking may have changed in the decade since that study was published, but the issue is still widespread enough for ACOG to address it in its 2017 report, writing, “Workerism father, in which a doctor overrides a patient’s right to self-determination to ‘protect’ her from the consequences of her own decisions. ”

The reluctance of some doctors may be a continuation of outdated medical standards. Throughout the 1970s, American doctors followed what is colloquially called “Rule 120“Accordingly, a woman cannot be sterilized until her age multiplied by her total number of children is 120. (For example, a 30-year-old patient would not be eligible for sterilization unless she has four children.) is no longer used today, some doctors remain secretive about the sterilization of young, childless patients.

Such is the case with Jacki Greavu, now 30 years old and living in Montana. She always knew she didn’t want to have children and started asking doctors to ligation for her when she was 22 years old. “They just think if you’re not 30, you’re not old enough to make this kind of decision,” says Greavu.

But she sure did, and finally found a willing doctor a few weeks before her recent 30th birthday. “I actually had an argument inside his office,” said Greavu. “It was great to finally have someone sit down and listen to me.”

Kluchin says medical paternity is closely related to the history of forced sterilization. While those deemed “unfit” for parenthood — often because of racist, class, or monopolistic thinking — may be pressured into sterilization, those often considered “good” parents—usually young, relatively affluent white women—could be denied the procedure. “It has to do with… the fertility of some women is considered beneficial, and others considered disadvantageous,” Kluchin said. “That trend continues.”

Clavell, a urologist in Houston, says he sometimes treats young men who say they’ve faced similar resistance when attempting a vasectomy. Coverage can also be a barrier. While most health plans must cover sterilization of women under the Affordable Care ActThe same is not true of a vasectomy.

Clavell says he tries to do a practice session where the patient is always in charge. “I’m not one to tell you what to do with your body,” he said.

It’s the attitude that reproductive rights advocates expect doctors to take across the board, whether they’re talking about sterilization, contraception or abortion. If people were trusted to direct their own reproductive health care, medical procedures wouldn’t need to become ubiquitous after a news story, Winter said.

“None of this should be trendy and none of it is politicized, whether it’s a vasectomy, abortion, tubal ligation,” she said. “It’s all about medical care.”

Other must-read stories from TIME


Write letter for Jamie Ducharme at jamie.ducharme@time.com.





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