Sterilizations: The “Last Resort” At Parkland

Peggy Stepney and her two children, who were both born out of wedlock, depend on monthly government checks and food stamps to survive, and the twenty-seven-year-old Dallas native knows the odds are stacked heavily against her dream of college for her children. For this reason, along with health problems brought about by her obesity, Peggy Stepney decided not to risk bringing other children into her life: she chose to be sterilized. In February, she was scheduled to have a tubal ligation at taxpayer-supported Parkland Memorial Hospital in Dallas.

Last year, more than 3,000 women like Stepney were sterilized at Parkland. Dr. Norman Gant, a professor and former chairman of the Department of Obstetrics and Gynecology at the University of Texas Health Science Center, predicts a record number of sterilizations in public hospitals in 1987. The rising number of poor women who are voluntarily sterilized mirrors a trend in the American population at large. According to the National Center for Health Statistics, some 16.5 million Americans (58 percent female, 42 percent male) have chosen contraceptive surgery from 1980 to ’85-up from 2.8 million in the decade of the Sixties. Sterilization is the most popular form of birth control, though the Pill remains the chosen method among females.

“The women we see come from West and South Dallas, but they are doing what people in North Dallas do,” says Gant. He believes that his patients, who are mostly black or Hispanic, have begun to feel that their ticket out of abject poverty is found in limiting the size of their families.

Increased interest in sterilization has raised some thorny medical, social, and ethical questions. For one, sterilization can cast the physician in the unwanted role of social worker. At Parkland, that may mean counseling patients with whom they have very little previous history. Parkland doctors often initiate the first conversation about sterilization, especially if a woman has health problems. But health professionals are wary of appearing to coerce poor women into having their tubes tied. With few exceptions, doctors follow federal guidelines that require the woman to be at least twenty-one years old, sign a surgical permit thirty days before the sterilization, and have the surgery done within 180 days after the permit is signed. “When we counsel a patient,” Gant says, “she can bring it up [tubal ligation] or we can bring it up. But the final decision always rests with the patient.”

Doctors have also voiced concern that at the age of twenty-one, a woman may be ill-equipped to choose a virtually irrevocable means of birth control (in 30 percent of cases, the surgery can be reversed). Parkland doctors and nurses recall the case of a young woman who for financial reasons decided to have her tubes tied after the birth of her second child. The mother and her six-pound infant girl were doing fine after the Cae-sarean section and tubal, when the health of the baby took a dramatic turn for the worse. The infant developed group B-strep infection, a systemic infection that often resists all antibiotics; twenty-four hours after birth and after her mother’s sterilization, the baby died.

Sterilization has not provoked the same broad controversy as abortion, but some religious and fundamentalist groups have voiced opposition. For instance, St. Paul Medical Center in Dallas and other Catholic hospitals will not allow staff doctors to perform tubal ligations unless they are approved in advance by an ethics committee and then only for medical reasons, specifically when a woman’s health could be jeopardized by pregnancy. Obstetric patients are sometimes transferred from St. Paul to other Dallas hospitals to be sterilized.

SMU professor of ethics Dr, William May, who writes and lectures extensively on medical ethics, suggests that society “downshift in the direction of more reversible means.” But some conventional and reversible forms of birth control have come under attack in court cases in which pharmaceutical companies have been ordered to pay damages. The famous A.H. Robins case has virtually removed the intrauterine device (IUD) from the market after it was found to cause injuries to some users. Doctors worry that over-the-counter contraceptive products soon may be eliminated from drugstores and supermarkets. A case against Ortho Pharmaceutical Corporation threatens future sale of spermicides used with condoms and diaphragms. The suit involves a baby girl with birth defects, whose mother used a spermicidal jelly for four weeks after conception. A lower court ruling was upheld on appeal.

“It’s a real dilemma,” says Gant. ’At a time when women have achieved some liberation, the choices [in birth control] are being removed in the courtroom.” And that, he says, leaves sterilization as a last resort for increasing numbers of women.