Done Having Kids: His and Her Options
What to consider about tubal ligation, vasectomy, and other options.
Traci C. Johnson, MD, FACOG
Some people reach this point in their lives after having many children. Or one child. Or even no kids at all. Some are in their 30s or beyond, and some have made up their minds even earlier.
Though their circumstances vary widely, millions of men and women have asked themselves these same two questions that go hand in hand: Do we have all the kids we want and need? If so, which one of us is getting “fixed”?
This him-or-her question should be decided with great care. For couples weighing whether they're ready to permanently prevent pregnancy, here are some important questions to ask.
Who’s Making These Decisions, and Why?
Men have one option when they want to permanently turn off their baby-creating hardware -- also called sterilization -- and women can choose from several. For men, the option is a vasectomy. A doctor cuts and seals off the two tubes that allow sperm to travel from the testicles to the outside world.
Women can have a tubal ligation, also called a “tubal” or “getting your tubes tied.” Her fallopian tubes are sealed off, keeping her eggs from meeting any sperm. Or a doctor can do an in-office procedure in which he inserts tiny devices into the tubes through the uterus, blocking them permanently.
Women take the leap nearly three times as often as men, says Sonya Borrero, MD, an assistant professor at the University of Pittsburgh. She researches reproductive issues and counsels female patients on their contraceptive choices. According to the CDC, about 16% of reproductive-age women had opted for tubal sterilization in 2002, compared to 6% whose partner had had a vasectomy.
“Some women feel that it’s their body and they want to have control of their fertility and they aren’t open to the negotiating process. They say ‘I want to make sure I don’t have any more kids,’” Borrero says.
However, men may have many reasons to shoulder the decision, says Grace Shih, MD, an assistant clinical professor at the University of California, San Francisco. She does research on the role of men in reproductive decisions, and also performs vasectomies.
“If a woman has had difficult pregnancies, that’s where men may feel like they have more responsibility. Or if women have difficulty using hormonal contraception, men may feel like this is their chance to contribute,” she says.
Him or Her? How to Make Sure
Though this decision can bring relief and freedom, it can also lead to regret and conflict for couples.
Discussing the following issues with your partner -- and yourself -- can ensure you’re making the right choice. These questions may be uncomfortable to ponder, but they may help you be clear about what's right for you.