Negotiating reproductive health: Experiences of patients seeking sterilization in gynecological care

Backround

Voluntary female sterilization (VFS), including tubal ligation or occlusion, as a permanent method of contraception, remains an underexplored research field in Germany. While VFS aligns with the human right to reproductive justice, access to sterilization care is often limited. These constraints on reproductive autonomy can have significant consequences for patients’ health, including psychological distress, pain, mistrust in healthcare providers and discontinuity of care.

Methods

In the context of a study on negative experiences of gynecological care in Germany, we conducted 6 interviews and one focus group with individuals (n = 4) having sought or still seeking sterilization. The content of the interviews was analyzed thematically.

Results

Patients seeking VFS face multiple, intersecting constraints on their reproductive autonomy. These occur on a structural level (e.g. referral requirements and dependence on gynecologist approval), institutionally (e.g. practice-specific age restrictions, denial of sterilization appointments), and on a relational level between physician and patient. Patients experience the need to actively negotiate their reproductive rights, while they report being paternalized, disrespected and insufficiently informed, with physicians disregarding their individual needs. Reported health consequences include psychological distress, lack of care and restricted reproductive autonomy.

Conclusions

The study reveals deficits in reproductive autonomy regarding individuals seeking sterilization in gynecological care in Germany. Patient´s experiences show predominantly preventable health consequences associated with disrespectful, paternalistic care practices. It highlights the need for empathetic, equitable and patient-centered gynecological care in relation to sterilization consultations.

Key messages

• Individuals seeking tubal sterilization in Germany face structural, institutional, and interpersonal barriers that restrict reproductive autonomy and require active negotiation of care.

• Paternalistic and disrespectful gynecological practices can lead to preventable harms, highlighting the need for patient-centered and equitable sterilization care.