Regret, Relationships, and Reproductive Autonomy- A Critical Narrative Analysis of Requesting and Receiving Tubal Ligation in Canada
Abstract
Tubal ligation (TL) is a popular and relatively safe form of permanent contraception most often used by women who are content with their family size and by women who do not wish to have children. This thesis presents the narratives of fourteen women who requested and received TL and illustrates the embeddedness of their decisions to prevent or end their potential for reproduction within sexist social discourses of pronatalism and medical paternalism. Guided by the concepts of reproductive justice, relational autonomy, reproductive labour, and health work, narrative interviews were conducted with women located across Canada and who requested, and in ten cases received, TL in order to remain child-free or to end reproduction after achieving a desired family size. The participant narratives were marked by complexities in the ways that women made decisions about ending their reproduction and are presented in five narrative threads: (1) TL as a resolution to complex reproductive histories; (2) forming and negotiating reproductive decisions within intimate and familial relationships; (3) negotiating medical authority and bodily autonomy; (4) TL and reproductive labour; and (5) complicating post-sterilization regret. The findings explore how women ascribe meaning to ending their reproduction through sterilization and the labour that they associated with requesting and receiving sterilization. Particularly, special attention is drawn towards the labour of gathering information about TL and the labour of self-presentation, both of which are symptomatic of systemic institutional failures to provide appropriate and equitable reproductive healthcare. The findings also illuminate how women make reproductive decisions relationally, both within their families and social circles, and in relation to broader social and institutional discourses. By incorporating women’s counter-narratives about requesting and receiving TL, this thesis also challenges the medicalized constructions of regret as a condition that should be avoided and the construction of TL as a simple surgical procedure. Storytelling can inform healthcare provider practice and education to highlight the complex nature of decisions about ending reproduction through sterilization and can be mobilized to facilitate social change by challenging post-sterilization regret and highlighting women’s reproductive labour visible and the ways in which pronatalism and medical paternalism constrain reproductive autonomy.