Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Polzer, Jessica

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.

Summary for Lay Audience

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. In Canada, it is the fourth most popular form of contraception and the first most popular among married women. TL is also used by women who do not have children and wish to remain child-free. Despite its popularity, the experiences of requesting and receiving TL have been largely unexplored in the research. This study collected and analyzed the stories of fourteen Canadian women who requested and received TL in order to understand how they made decisions about ending their reproduction and what their stories tell us about how their decisions are restricted and shaped by pronatalist ideals embedded within medical encounters and broader social discourses and cultural narratives that place expectations on women to reproduce. The findings from this study detail the extensive work women engaged in to request and receive TL, including work involved in gathering information about sterilization, finding healthcare providers who would sterilize them, telling and re-telling their TL requests when they were passed from one healthcare provider to the next, managing their self-presentation to boost their chances of getting sterilized, managing the sterilization procedure itself, and performing emotional labour in intimate relationships regarding contraception. The stories challenge the assumption that women regret their decisions to get sterilized and illustrate the range of meanings that women ascribed to TL. For many women in this study, being sterilized meant sparing themselves and their partners from the future emotional toll of miscarriages. For others, TL was a way to affirm their identities as “child-free”. The study findings show how storytelling can be used to provide a better understanding of the complex ways in which women make decisions about ending their reproduction and navigate pronatalist expectations in their health care encounters. Further, these findings can be used to create meaningful change in women’s reproductive healthcare by centering women’s experiences and fostering critical reflection and discussion in medical practice and education.

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