Sterilization laws in the USA
In the early 20th century, several states passed laws allowing forced sterilization of mentally incompetent persons and criminals. These laws were disproportionally targeting African American women, Native American women, and other minorities. Institutions and doctors also often tricked these groups into giving consent to sterilization by not informing them properly about alternatives and consequences. Institutions and doctors have also pressured these minorities into undergoing sterilizatoin by threats of revoking welfare benefits. It was not until 1979, that the U.S. Department of Health, Education, and Welfare released federal regulations on informed consent about alternatives and consequences—and clear confirmation that no welfare benefits will be affected. 1
As a result of this dark history, doctors in the USA will often be reluctant to perform voluntary sterilizations to avoid any potential allegations.
Voluntary tubal ligation is legal in the USA for any informed woman above 18 years, who is mentally capable to understand the alternatives and consequences. In some states, the minimum age is 21 years. There is no official number of children requirement. While some states have spousal consent laws, these federal law deems these laws unconstitutional and are therefore not in effect. 2
For federally funded health insurance plans, the prospective patient has to give informed consent at least 30 days but not more than 180 days before performing the procedure. Private insurances might apply their own waiting periods. 3
In practice, women under the age of 30 without children often experience heavy pushback and refusals from their doctors. 3
Tubal ligation costs in the USA
Under the ACA, health insurances have to cover at least one method of female sterilization at 100%, so there are no costs for you. Your health insurance is not allowed to charge you any deductible, copayment, or coinsurance. If you have access to Medicaid, your tubal ligation will also likely be covered, but you have to be at least 21 years old and give consent at least 30 days before the procedure. 4
You have to be careful with the fact that health insurance only covers one method. Depending on the billing codes the hospital uses, you might run into problems with getting your tubal ligation covered. You should contact your insurance beforehand and obtain written confirmation of the covered billing codes. Check-in with the hospital before the procedure and receive confirmation that they are indeed using these covered billing codes. If you are getting a bilateral salpingectomy, you often have to make sure that it is billed as “tubal ligation via salpingectomy” to receive the full cover.
If you have no health insurance, the total costs of the tubal ligation can be up to $6000. Make sure to ask for an itemized bill, so you can check what exactly they are charging you for and how much. 5
Sterilization process in the USA
If you already have a regular gynecologist, make a dedicated appointment with them to talk about tubal ligation. Otherwise, make an appointment with your GP. By making a dedicated appointment, it will be much more difficult to shrug you off. Don’t go into this appointment unprepared. You’ll have to show that you know what you are signing up for. Have a look at our tips on how to talk to your doctor for more information.
If you manage to convince your gynecologist, they might be able to perform the procedure themselves if they are also a surgeon. If not, they will give you a referral to a qualified surgeon. Once you get a referral, you’ll have to make an appointment with the surgeon. Depending on the surgeon, you might have to wait a few weeks until they have an appointment available. During the appointment, you’ll have to show again that you are 100% sure about your decision, but it will work in your favor that another doctor has already signed off on your tubal ligation.
After this appointment, your surgeon will schedule an appointment for the actual procedure. It often has to be at least 30 days after you gave your informed consent.
If you are young and childfree, there is a good chance that your primary doctor will deny your request at first—even if you are well prepared. Don’t give up and try to see a different doctor who is more open to the idea. It is also worth trying to contact surgeons directly since some of them are willing to perform a tubal ligation without a referral.Notes
- Source: https://en.wikipedia.org/wiki/Eugenics_in_the_United_States
- Source: https://scholarship.law.umn.edu/cgi/viewcontent.cgi?article=1247&context=lawineq
- Source: https://wtop.com/center-for-innovative-gyn-care/2016/06/the-guise-of-choice-the-u-s-female-sterilization-controversy/
- Source: https://www.healthcare.gov/coverage/birth-control-benefits/
- Source: https://www.plannedparenthood.org/learn/birth-control/sterilization/how-do-i-get-tubal-ligation-procedure