“What about when you and your husband get divorced, and you meet someone else?”
She said when. The gynecologist’s voice was steady and detached, but her lips pursed in a condescending smirk and her eyes gleamed. I was 25 years old and had married my best friend three years earlier. Everything about being married brought me joy. I certainly had no intention of getting divorced. She paused briefly before delivering the final blow.
“What if Mr. Right wants children?”
She seemed to take pleasure in my inability to give an immediate response, but if I stumbled on my own thoughts, it was only because I was reaching for a response that would not get me thrown out of the gynecologist’s office. I finally went with: “That would mean he is not Mr. Right.”
Her patronizing smile told me she was not satisfied.
“My husband has nothing to do with my desire not to have children,” I continued, hoping I did not look as flustered as I felt. “I knew before I met him that I did not want children. In fact, I was the one who first brought it up with him.”
I only ever considered having children at the insistence of others
In my memory, she is peeling potatoes. I don’t know if that’s exactly what she was doing, but she had her back to me and was engaged in some important back and forth between the sink and the stove. I was 8 or 9, and I was planning on becoming a fighter pilot or a lawyer, depending on the time of day.
“Isn’t it selfish to have children?” I asked her.
“What do you mean?”
“Well, the baby doesn’t exist yet, so you can’t be doing it for the baby’s sake. You don’t know what it wants. That means you’re creating a human being just because you wanted a child.”
I don’t know if she stopped peeling potatoes and came to sit with me at the kitchen table while she responded. I might have that mixed up with the time I asked her if falling out of love isn’t actually a sign of never having been truly in love to start with. The best time to ambush my mother with difficult questions is while she’s cooking — her attention may be divided, but she isn’t going anywhere anytime soon.
“Yes, I suppose it is selfish,” she said. Anything she said after that did not matter; I had my validation that it was okay for me not to want to have children.
The first time my friends asked me in all seriousness how many children I was going to have, I said zero. We were 14, and although I was not very concerned with fitting in, reading the room, I sensed I had said something that should not be repeated.
“I might adopt an older child one day,” I conceded when the topic came up from then on. “I might have biological children someday.”
On some days, even I believed those words. But at 19, I realized something crucial: I had only ever considered having children at the insistence of others. For the first time, I let myself think about all aspects of parenthood from the perspective of what I wanted, and one thing was certain — I did not want to be a parent.
“You will change your mind,” people told me. “Maybe I will,” I said. “But knowing me, it doesn’t seem likely, and I can’t live my life based on unlikely scenarios.”
What it took to convince my gynecologist to even consider sterilizing me
The gynecologist’s condescending smile faded slightly. She wanted to know why I was in such a rush. Why I had come into her office only a week after reaching the minimum age legally required to ask for sterilization without the intervention of social services. “You will still be able to have this procedure at age 30 or 35.”
I have never understood how following up on a decision more than 15 years in the making was rushing simply because I was 25. But my brand new gynecologist was not the only one convinced that I was rushing things. That was also the opinion of 100 strangers, who expressed themselves in significantly more misogynistic terms in the comments field of the interview I gave to the local newspaper after a journalist deemed my life choices newsworthy.
“I am an archaeologist,” I told the gynecologist with the relative calm of someone answering an emotionally loaded question with a rehearsed response. “I don’t know if I’ll be living in a country where abortion will be available to me should I become pregnant.”
This was no exaggeration. I still lived in Sweden, where I was born and raised, but many of my peers were settling temporarily in Ireland, where large-scale infrastructure works put archaeologists in high demand — and where abortion is still illegal in most instances. In the summers, I worked in countries where I couldn’t legally bring half of my book collection, much less get an abortion should the contraceptive implant in my arm fail. My husband and I were open to moving to such a country if I got a more permanent position.
The way she snorted at my concern made it clear she did not understand what it means to struggle financially or to leave your country for a job because you desperately need one. In her mind, I could always pay to abort the pregnancy I was attempting to avoid should I not be covered by some national health care system abroad. I could also fly back home to Sweden, she told me, where health care is next to free. Her disregard for my financial situation aside, this was simply not true. Swedish citizens who live abroad are not eligible for subsidized elective health care. This woman held the keys to my future, and she intended to make her decision based on ignorance.
“I am also concerned about the rising conservative trend globally,” I carried on. “I can’t be sure that I will be able to get an abortion in 10 years, much less get one wherever I might live.”
Her half-laugh and the way she turned away to compose herself before looking down her nose at me made her feelings absolutely clear. Child, her eyes said, don’t be stupid. You live in Sweden, and the world is always going to get better and better. This was 2009, and the far-right conservatives who want to restrict access to abortions were not yet the second-largest party in the opinion polls. “I am going to refer you to a therapist here at the hospital. If you can convince her, I will approve you for the procedure.”
I specifically wanted the Essure procedure because it was the option with the lowest impact on the body — a nickel titanium coil is inserted into each of the woman’s fallopian tubes through the vagina. Her body then responds to the intrusive metal by growing new tissue around it until the fallopian tubes close up, effectively stopping the eggs from ever meeting sperm.
At the time, fewer than 30 hospitals in Sweden had the necessary training to administer the procedure. Out of the 10,000 women in the country sterilized that year, 0.06% chose Essure. Tubal ligation (“having your tubes tied”) remains the ubiquitous choice.
I had spent months poring over testimonials and documentation detailing all available types of sterilization, regularly presenting my findings to my husband. Together we decided on Essure because of its less invasive nature and shorter recovery time. If I was unable to get the procedure, we decided my husband would ask for a vasectomy.
“My job is to determine that your aversion to having children is not the result of a fear that we can cure”
The dark and empty hospital corridor leading to the therapist’s office was not wide enough for a medical emergency. There was no waiting room. I had the distinct feeling that this corridor was not meant for me. I was nervous about the amount of power the stranger behind the door might wield over my future. This is what I imagine waiting outside of the headmaster’s office feels like.
The office could barely fit her desk. When I sat down opposite her, I tucked my feet under the chair so I would not accidentally kick her toes.
As I answered questions about my parents’ marriage and my early childhood, my mind explored strategic options. Would the truth about my brother’s autism and sister-in-law’s cerebral palsy highlight my understanding of parental sacrifice and lifelong commitment, or would it be twisted into a convenient scapegoat for my unconventional stance?
“My job is to determine that your aversion to having children is not the result of a fear that we can cure,” she said.
I decided to tell the truth, no matter how inconvenient.
After almost two hours of exploring my feelings and extolling the uneventfulness of my happy, sheltered middle-class childhood, after I was told to lean back in the uncomfortable office chair and imagine myself cradling my newborn infant, I was allowed to leave. It was concluded that there was nothing a professional could do to heal me of my deviation.
What the sterilization procedure is like
A nurse showed me across the open floor plan to the empty bed in the corner, ticking off boxes as I responded to questions. Fasting? Check. Pregnancy test completed? Check. “Please change into your gown and take off any jewelry and hair clips. I will give you some privacy.”
I was just about to lift my shirt when the curtains parted and a man with white hair and in scrubs appeared briefly inside my makeshift changing room. As I unhooked my bra and reached for the hospital gown, he wandered in again, apparently too short a visit to say hello or sorry but long enough to get a clear view of my mostly naked body. Ten minutes later, when my clothes were safely stowed away and I had left the privacy of my changing station, he was introduced to me as my doctor.
Fifteen minutes later, I rolled into an operating room on a bed with a drip attached to my arm, just in case. This type of sterilization can technically be done in a gynecologist’s office, since there is no need for sedatives or a blade. Operating rooms, however, are better equipped than gynecologists’ offices.
I don’t remember the words he spoke, but my new doctor’s first full sentence directed at me was hissed in irritation. He scolded me for coming in while I was on my period. We would have to cancel the whole thing and reschedule. He did not say so, but the undertones were clear: I had wasted everyone’s time and money either by ignoring procedure or by lying to the nurse who scheduled me.
I tried to steady my fear and shame as I told the angry stranger between my thighs that I’d had my period two weeks earlier, but stressful situations cause me some minimal breakthrough bleeding, rarely more than two or three drops of blood in total. That was what he was seeing. I swallowed hard, and tried to sound as authoritative as one can while on one’s back and naked from the waist down. “We can reschedule, but I doubt it will be less stressful next time,” I said.
Everything went well up until the cervix. Not having borne children into this world, it turned out that mine was smaller than the catheter used to guide the metal coils into my fallopian tubes. My doctor’s solution was to simply hammer the tool with brute strength against the opening in the hope of forcing it through. The logic was sound. The two female nurses between my legs grimaced in horror just before pain shot through my body. I tried to focus on my breathing when it hit me again, and again, and again.
I stared into the bright lights above until the nurse anesthetist squeezed my hand and leaned in over me. He wanted me to voice my desire for pain relief. He extolled its virtues, the ease with which it could be administered, and how soon it would help me. I couldn’t tell if I needed any. The pain was terrible, but my mind was rationalizing it. It would all be over any moment now, I told myself. He asked me one more time if I wanted pain relief. I nodded. The pain shot through me again. Twice.
I don’t remember the doctor’s words. I simply remember that he had no intention of stopping. Pausing for pain relief would take one minute. To him, it seemed, my pain was a reasonable price to pay for that minute saved. Each time I recall this moment, the nurse anesthetist’s raised voice sounds more and more like a lion’s roar. I don’t remember his words, either. He told off an older man with a fancier degree, who clearly was not used to being talked back to, and relieved me of the source of my pain until the chemicals in my bloodstream would take the edge off it. He was my hero.
My doctor’s dismissive post-operation commentary
I was in a rush to leave. I had made big plans to spend the rest of the day in bed, watching films while eating large quantities of ice cream and small to moderate quantities of pain medication. My husband was on his way to pick me up. His big plan for the day was to hold me and to refill my ice cream.
Waiting around to be debriefed by the doctor was not on anyone’s schedule, but the nurses assured me that a short talk about how the procedure went was desirable. They left me in a windowless room the size of a confessional with two chairs facing each other. A few minutes later, my doctor arrived to tell me that the sterilization he had performed on me had gone well.
“You know, when you regret this, a few years from now, the government will no longer subsidize your in vitro fertilization.”
He said when.