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Dr. Ghada Hatem (Gynecologist)
In 2023, a woman who wants to use a permanent method of contraception such as tubal ligation, faces many obstacles as soon as she talks about her project in front of a doctor. A story of choices that is still hard to pass. State of play.
Being a woman does not necessarily mean wanting to be a mother, or wanting to conceive again. As such, there are many articles and testimonials from young women that flourish on the various media and social networks to express their choice loud and clear. But this choice becomes more difficult to apply when it is a question of definitive female contraception, that is to say tubal ligation, whatever the method used. The definitive nature of the act still raises questions for many practitioners.
A medical act yet legal and authorized since 2001
Permanent contraception is however an act authorized since 2001 to any woman from the legal age of 18 years. It responds to an established framework:
- The ligation of the fallopian tubes or vas deferens for contraceptive purposes can only be performed if the adult person concerned has expressed a free, motivated and deliberate will in consideration of clear and complete information on its consequences;
- This surgical act can only be performed in a health establishment and after consultation with a doctor;
- This doctor must during the first consultation: inform the person of the medical risks that he incurs and of the consequences of the intervention and give him a written information file;
- The operation can only be carried out after a reflection period of four months after the first medical consultation and after written confirmation by the person concerned of their wish to undergo an operation;
Finally, a doctor is never required to perform this act but he must inform the person concerned of his refusal from the first consultation. A refusal for conscience clause that many young women still face, yet ticking all the legal boxes, and even if they have actually received all the information on the consequences of their decision.
A sometimes difficult position for the doctor
For Ghada Hatem, obstetrician-gynecologist and member of our committee of experts, questioned on the subject, there is still a difficulty for the practitioner, who until 2001 had to pose as a decision-maker, and who today sometimes remains uneasy comfortable with the definitive nature of the ligature:
“We say to ourselves ‘Well, at 18, life is long, she can change her mind 25 times. And that puts us in a somewhat difficult position, of censors, of ‘I authorize’, ‘I do not authorize’.”A position that she considers unpleasant and of which she understands the difficult scope. For the gynecologist, an idea still persists “I’m going to participate in something potentially irreversible, in a very young woman, who may change her mind, and I’m going to blame myself” she continues.
A concern of conscience that arises much less with vasectomy, for example, permanent male contraception since, as the gynecologist claims, “it is always possible to have your sperm frozen before this decision”.
But a choice that must be up to the woman
However, Dr. Hatem compares several situations and choices, which are the responsibility of women and which cannot be considered as double standards:
“An 18-year-old woman should be able to ask for things about her body. We cannot at the same time campaign for women to be able to abort when they have decided to abort and have a discourse and an attitude that is too paternalistic in other cases”
She also invites people who still have questions to turn the situation around:
“We can also say to ourselves that this woman will perhaps avoid 15 years of contraception, that she will not take hormones, that she will not have an IUD which, potentially, can cause her an infection or suffer from ‘abortion for unwanted pregnancy’.
And finally, even if this woman had made a personal choice that she regrets, the gynecologist wants to be reassuring: “We have nevertheless made good progress in in vitro fertilization, it is now possible to help her become pregnant if she wishes.
My trunks, my choice, a book to embrace the subject
The subject of sterilization is more topical than ever, at a time when some women claim a choice, that of not being a mother or of choosing contraception. January 17 comes out on this my fallopian tubes My choice, Contraceptive sterilization: from oppression to liberation published by Le Passager Clandestin. An eloquent title in which the author Laurène Levy, health journalist, deals with contraceptive sterilization in all its aspects, the consequences of a painful history and the symbolic obstacle that is grafted onto this debate: that of accepting that a woman has the right to emancipate herself from the injunction to maternity.
