Female sterilization surgery like a tubal ligation isn’t cheap. If you don’t have a lot of money, this might make you wonder how a tubal ligation compares to other birth control methods that aren’t permanent, like the pill and the IUD. With one dataset from one country, we made these comparisons on a case study: Jane from the United States of America (USA)1. Comparing the lifetime cost of birth control in other countries will look very different.
Please note that SterilizationAunty is only for women who are sure they never want to have biological children of their own from this point forward. This piece is not meant to convince anyone to choose sterilization simply because it’s cheaper than another form of birth control. Only choose sterilization if it’s right for them.
Jane’s birth control scenarios: the pill, Implanon, IUD, and tubal
This is Jane from the USA. She knew all her life that she never wanted children. Even at age six she rejected playing with baby dolls and prams. Let’s assume she started menstruating at 12. To control her periods and acne, she started the pill in her teens. At age 18, she wanted to get female sterilization surgery, as is her legal right to ask for. We know from Jane that menopause will hit exactly at age 50. So there are 32 years where she’s an adult and is fertile.
Let’s look at four scenarios for Jane. In three cases, no one grants her sterilization and she’s dependent on short-acting and long-acting reversible contraception her whole fertile life. In the second case, she receives a tubal ligation at age 18 and lives happily and worry-free through her young years, menopause, and beyond.
We took the upper limit of prices from each method of birth control from this factsheet from 20121. In all these scenarios, we assume that Jane doesn’t have health insurance. Jane is smart about her sexual health, so she also uses condoms. The cost of condoms to protect Jane against STIs isn’t included in this.
None of these scenarios take into account the cost of birth control before the age of 18 because Jane’s parent paid for that.
Scenario 1: the pill
Jane starts the pill at age 18. This costs her US$1,210 each year. Over 32 years, this cost her US$38,720 until she hit menopause. Jane could have invested that money in her education or index funds.
Using the pill since even before the age of 18, the side effects of the pill haven’t gone unnoticed. Sometimes, she forgot to take the pill and used emergency contraception like Plan B. Her doctor sometimes judges her for that. After lawmakers have banned abortion in the USA, lawmakers have threatened to make Plan B illegal too. All these things stress Jane out a lot and affect her mood.
She also uses a lot of ibuprofen for her headaches and the irregular spotting that sometimes happens forces, Jane, to buy new undies more regularly.
Scenario 2: the Implanon
At age 18, Jane’s doctor puts an implant into Jane’s left arm for the first time. It lasts three years and needs to be removed and replaced. This costs her US$1,100 every time she gets an arm implant. Over the 32 years, this costs Jane US$11,733.
Due to the many insertions and removals of her 11 implants, her left arm looks like a battlefield. There are so many scars and there’s even some nerve damage from that one doctor that manhandled her. Thrice, the Implanon was so overgrown with scar tissue, that Jane was sent to the hospital to let a capable surgeon remove it.
Though Jane’s so happy that her menstruations were sometimes non-existent for years, she didn’t always trust that the Implanon was still working. Jane’s acne has remained over the years and sometimes her vaginal discharge is abnormal and causes her to worry.
Scenario 3: the intrauterine device (IUD)
In this scenario, Jane gets an IUD at age 18. On average, her IUDs cost US$1,000 and she needs to replace it on average every 6 and a half years. Five IUDs and 32 years later, this cost Jane US$5,000.
Jane tried both the hormonal and the copper IUD. Insertion and removal were always super painful. The very first time, Jane’s uterus expelled the IUD, which forced her to get medical attention and buy a new IUD. This left her quite traumatized because it’s not easy to insert an IUD if you’ve never given birth.
Jane also experienced pain during sex and was sometimes worried that her partner or her menstrual cup would accidentally pull out her IUD. This worried Jane especially during her third IUD when the doctor had cut the strings in a way that they were too long. Jane’s breasts are also very tender sometimes, which sometimes messes with her sleep.
Scenario 4: tubal ligation (female sterilization surgery)
Jane has argued with Dr. Lawrence – Jane’s GP – since she was 12 that she wanted to be sterilized. She always knew she couldn’t get the procedure as a minor, but she knew it was important to vocalize her wish to remain childfree at regular intervals over many years. She made sure that Dr. Lawrence wrote it down in Jane’s file. Jane’s doctor has seen her grow up from a girl into a confident young woman. There’s a trust between the two.
On Jane’s 18th birthday, she gives Jane the referral to a gynecologist called Dr. Vardanyan. She reads Jane’s file and sees a pattern of pleas. During their appointment, Dr. Vardanyan tests Jane’s knowledge and establishes informed consent. Though the request is perhaps unusual because of Jane’s young age, Jane is an adult now and can make her own medical decisions. Dr. Vardanyan scheduled Jane’s tubal ligation for as soon as there’s an opening.
A week after Jane’s 18th birthday, she walks out of the hospital with a bag of painkillers and the confidence that she will never be pregnant. Ever.
The cost? US$6,000. Lifetime.
Jane still bleeds, but she’s not putting hormones in her body. Her scars have faded within a year of the surgery, but the skin there is still sensitive. She feels in control of her life and manages to put a lot of energy into her passions, work, and relationships with friends and her partner. Although she sometimes fears that her tubes have regrown, this fear completely disappears after her five-year tubalversary. It has been great for her mental health.
Some people she dated before settling down thought she wasn’t serious when she said she’s childfree. Though her online dating bio said “childfree people only”, not a lot of the men took this as a hint. A few of them – especially the men – tried to persuade her during first dates, saying shit like “but our babies would look so cute” and “you’d be such a great mom”. Their tune changed when Jane laughed in their face and told them she’s sterile, after which she would pay the bill and walk away. She eventually found a partner with her same values, who is also sterile. Together, they share their distraction-less life.
Notes on the price comparison
Many women try different types of birth control throughout their lives. Some women even rely only on condoms for years to prevent pregnancy. There’s a very low chance that Jane would only use the pill for 32 years and not come up with a more cost-effective way to stay childfree. It’s very normal for women to try the pill, then the IUD or Implanon, only to arrive at sterilization after many years of trying out different things.
Of course, scenario 4 is very unlikely in the culture of the USA in 2020; Jane would have a really hard time convincing a doctor to sterilize her at age 18. Everything after the sterilization is quite realistic. Complications are rare
Scenarios 1, 2, and 3, are very realistic though. Especially because many women experience side effects of their birth control over the years. Many women attribute the pain, inconvenience from these side-effects as just part of womanhood. This isn’t necessarily true and SterilizationAunty encourages you to not suffer in silence. You deserve a form of birth control that works for you.
- Source: American Progress, published in 2012. You can download the report here: USA birth control costs ↩ ↩