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Bleeding started at 10pm on Saturday 22nd July.

Paula* (Chilean, 30 years old) at home. She thought it was her period, but after a while she got scared. There is too much pain and blood.

He decided to go to the hospital. Upon arrival, the doctor told her: “You have lost a lot, you have had a miscarriage.”

His surprise was complete. Such news is absolutely unexpected.

Paula made a decision years ago: i don’t want to be a mother Not under any circumstances.

Her birth control pills failed, and she regretted once again that no doctor was willing to operate on her. surgical sterilizationThis is a wish he has had since he was 18 years old.

“None of this would have happened if my fallopian tubes had been tied. It was not a pleasant experience and I am annoyed that I have spent years looking for a professional Help me fulfill my desire not to be a mother”,’ he told BBC Mundo a few days after the loss.

What is it and what are its requirements?

Paula represents thousands of women in Latin America who are unable to undergo voluntary sterilization, a so-called tubal ligation.

The efficiency of the process is The contraceptive rate is over 99%making it one of the safest methods.

In fact, the World Health Organization (WHO) lists it as one of the few “very effective” birth control pills.

Also, it does not affect hormone levels in the body (As with other birth control pills), this is a considerable advantage for many women because it has no “side effects”.

How is tubal ligation performed?

  • Female sterilization prevents the egg from traveling down the fallopian tubes that connect the ovaries to the uterus.
  • This means that a woman’s egg cannot meet the sperm and therefore cannot be fertilized.
  • There are several ways to block a fallopian tube, from using clips, silicone rings, to ligating or cutting a small section of the fallopian tube.
  • This is a relatively simple procedure, usually performed on an outpatient basis. This is done with laparoscopy.

It differs from other birth control methods such as the pill, IUD, vaginal ring, patch, or injectable ampoules in that It is permanent and irreversible.


Paula didn’t want to have children. This is a decision he made 12 years ago. “I never wanted to be a mother. I never had that spark they say,” he said.

For women who decide not to have children, this could be an important benefit because they no longer have to worry: neither need to take the pill every day nor change devices every month, nor need to continue to spend money on contraception medicine set.

However, for many physicians, this is the main cause of their Don’t practice it.

This is especially the case if the women are young and have not had children.

This happens even in countries that are supposedly protected by law.

the situation is like this Colombia, Argentina, Brazil, Mexico or Chile, It is considered a “reproductive right”.

To promote responsible motherhood and fatherhood, most countries require that women must aldultmake the request in writing (by signing the informed consent) and in programs exposed to Sexual and Reproductive Health Counseling by the treating doctor.

A woman takes birth control pills

According to doctors consulted by BBC Mundo, many women find it difficult to stick to a daily pill and therefore prefer more defined solutions.

But, in many cases, the above translates into a series of an obstacle that makes things very difficult Get a tubal ligation.

This is the case of Paula, who expressed her wish to be sterilized three times, but received negative answers in the doctor’s consultation.

“I first applied at the age of 23, in the Chilean public system. The doctor told me no, I was young, I hadn’t left university and I would change my mind”, she said.

“The second time I was 25, the answer was the same: He is not mature enough to make such a decision. The third time, just three years ago, they shut the door flat and told me that if I wanted a tubal ligation, I should ask for it abroad.”

Her latest pregnancy, though unsuccessful, has her on her toes.

“Other birth control pills always fail. That’s the problem,” he said.

“I already want to forget about it. But I can’t,” he added.

waiting list

One of the biggest problems facing women who want to have the procedure for free is long waiting list This is the case in most public health institutions in Latin America.

For women without children, the situation is more complicated.

“In the public system, the waiting list is long and childless women are not a priority. They are therefore forced to use other contraceptive methods to fend for themselves”, commented the obstetrician. Gabriel ZambranoA program from the Itenou Medical Center in Caracas, about a reality in Venezuela that is repeated in countries of the region.

doctor giving advice to woman

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In most countries, medical teams are obliged to advise women who want to be voluntarily sterilized.

According to the latest UN family planning report, The covid-19 pandemic has exacerbated this situation, Reduce women’s access and access to contraceptive services, especially irreversible services such as sterilization.

The United Nations recognizes that the reality is worse in low- and middle-income countries and among the most vulnerable groups.

In this way, voluntary sterilization ends up being easier for able women Pay privately.

the situation is like this Amanda TrevoraA 34-year-old Chilean woman has been sterilized 16 years after requesting it.

“In the public system, no one wanted to operate on me because I was young, or because I didn’t have kids…so I ended up in the private system. And it was very expensive. That was the biggest hurdle”, he told BBC Mundo.

amanda has to pay 4 million Chilean pesos (approximately $4,800).

“They can tell you everything, the problems are very hard. People have to deal with them. But if you don’t have money, everything goes down the drain,” he said.

gender bias?

But there is also a cultural problem.

he promised Francesca CrispiA doctor, scholar and dean of the School of Medicine in Santiago, Chile, has been studying women’s sexual rights for many years.

“In Latin America, there is an issue of women’s autonomy in the doctor-patient relationship. There is a general perception that women cannot make decisions for themselves, that they are very emotional,” he warns.

“There’s this notion that all women should want to be mothers, and if they don’t then, Then they will regret it”Add to.

In fact, Gabriel Zambrano, an obstetrician and gynecologist, affirms, “Our greatest fear is that women will regret it…We doctors may be accused of cutting off our patients’ fertility.”

Yet for women consulted by BBC Mundo, doctors’ fear of repentance often meant their reproductive rights and freedom of decision.

“What people say about women is that they see us as babies and they make us think our decisions are hasty and not thought through,” Paula said.


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The doctor explained that the issue of female sterilization is not a priority because there are various ways to avoid pregnancy.

All of these are added religious debate.

“Some centers do not offer certain contraceptive benefits for religious reasons, although conscientious objector is not regulated in these cases,” Crispi said.

On the other hand, the scholar assured that although the laws of many countries clearly state that women do not need get your partner’s permission To get this procedure (as is the case in Argentina or Colombia), the reality is that there are still health centers that require it.

“We’ve had a lot of cases where they’ve asked the couple for their opinion, and that ends up being a huge hurdle,” he said.

Paula remembers that this was one of the questions she got when she expressed her desire to have her fallopian tubes terminated.

“It’s like your husband owns your decisions. It’s a very archaic and patriarchal look because it’s a personal decision,” he said.

In the case of Spain, the situation seems to be different.

according to the doctor Jose Cruz QuelezPresident of the Spanish Contraceptive Society (SEC), if a woman has not given birth, there are no other problems.

“Here, if a woman wants to have her fallopian tubes ligated, it’s done whether she’s been a mother or not,” she explained.

“It’s their right,” he added.

For Francesca Crispi, all the obstacles that exist in Latin America are problematic because Contraception is “time dependent”.

“If a woman is denied, it could mean she has an unwanted pregnancy in the short term. So, refusing certain types of contraception seems problematic to me,” he noted.

The above becomes even more important when United Nations data on unwanted pregnancies are considered: according to the international organization, Between 2015 and 2019, 121 million people became pregnant, Accounts for 48% of all pregnancies.


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Tubal ligation is done by laparoscopy. This is usually a relatively simple outpatient procedure.

some data:

  • Female sterilization is the most widely used method of contraception in the world, according to the United Nations Organization.
  • According to the latest Family Planning report, 219 million women were sterilized in 2020, equivalent to 23% of women who used contraceptives.
  • Male sterilization, on the other hand, is much lower: 17 million men were sterilized, or 1.8%.
  • The Dominican Republic, El Salvador, Mexico and Colombia have the highest rates of female sterilization in the region, according to the United Nations.

“It’s finally over”

Two years after being sterilized, Amanda Trevira says she feels “peaceful and happy”.

She remembers being approached by a midwife in her 50s as she entered the ward for surgery and told her something she would never forget.

“He told me: ‘I think what you’re doing is very valuable. I’m not of your generation who can make these decisions. I never wanted to have children, but no one wants to operate on me. I’ll be here Take care of you.”

Amanda confirmed that it was there that she understood that she was part of an organization. “The group of women who live in the throes of this disorder, problems, as if we are emotionally and hormonally weak.

When Amanda woke up from surgery, she started a new life. “I feel an infinite peace.

I thought: ‘It’s finally over'”.

Paula now lives in a different reality.

Just recovering from a recent abortion, she pledged that she no longer had the energy to continue trying to be sterilized.

“Maybe in a few years, I’ll meet someone who thinks I’m the right age and maturity to have my fallopian tubes ligated.”

“Meanwhile, my partner will have a vasectomy Because they don’t give him any questions, they don’t ask his age, or if he has kids,” he said visibly upset.

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*Paula is a pseudonym as the interviewee did not want to reveal her identity for personal reasons.

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