Abby Ramsay, a 26-year-old actor based in Los Angeles, blew up on TikTok when a tongue-in-cheek video of her doing a “sterilization reveal” went viral on her account @abbysworldsastage. You might be familiar with the garish “gender reveal” videos that circulate social media (most likely from your long-lost high school friends): a circus of balloons, confetti and glitter cannons, where soon-to-be parents announce the gender of their future child to friends, acquaintances and mocking strangers via the prescribed blue-or-pink colour. But what is a sterilisation reveal?
At the time of the reveal, Abby was 24 and six years into a gruelling journey to find a willing Obstetrician-Gynaecologist (OB-GYN) to perform the surgeries she had wanted since she was 18. These surgeries included a bilateral salpingectomy (removal of the fallopian tubes) and endometrial ablation (the removal of the endometrium, which a fertilised usually attaches to). “I knew when I was a freshman in high school that I didn’t want children,” Abby says. “I told every doctor, ‘I’d rather regret not having kids than have kids and regret having them.’”
In 2022, finding a doctor that agreed to do the operation was a big win for Abby. She shared the video as a playful update and long overdue celebration for the followers who had supported her through other doctors’ rejections, troll accounts and the perpetual feeling that her body was not hers to make choices over. With the provocative caption on the video reading, “I’m excited to take control of my own body. I’m not a baby maker,” the video rocketed into the hands of over four million people, many of whom strongly objected to Abby’s decision as a 20-something, unmarried and childless woman, to surgically ensure that she will not be making babies, now or ever.
Given our planet’s imminent climate crisis, an unending pandemic, and the overturning of Roe v. Wade — all combined feel like a perfect storm of existential threats — discourse around child-free lifestyles is at an all time high for younger generations. The largest study on climate anxiety and young people to-date found that 40 percent of Gen Zers surveyed worldwide are hesitant to have children because of climate change. A second study found that nearly half of millennial Americans said they don’t want children, a steep statistical drop since pre-pandemic and pre-abortion-bans. Under the TikTok hashtag #sterilization, there is an explosion of videos posted by women in their 20s engaging in discourse around the subject of sterilisation and sharing hard-to-find resources with their community on TikTok.
While the journey for Abby started during high school in her hometown in Sellersville, Pennsylvania, she started documenting the process in 2021 on her TikTok page. Amassing over 30k followers since then, Abby has shared the onerous process of getting sterilised: the countless rejections by condescending doctors, mindful responses to questions around fears of regret, helpful tips on her process of questions to ask doctors about surgery preparation and, most recently, a one year post-op showing the healed scars – just two small incisions on her lower abdomen. To her group of eager viewers, some of whom may be undergoing a similar hunt, it’s evidence that the journey for women seeking sterilisation isn’t as straightforward as it should be.
“To get a tubal-ligation, all you have to do is go to see an OB-GYN, tell them that you’d like to have your tubes tied or removed and then you get scheduled for surgery”, obstetrician-gynaecologist Dr Franziska Haydanek says. She pauses, then adds hesitantly: “Well, technically.”
In reality patients — particularly younger women who don’t already have children — often face disheartening obstacles when seeking elective sterilisation. “I thought maybe if I only saw women OB-GYNs, they would be more likely to take me seriously,” Abby says. “But even then, every single doctor was condescending. Some were outright rude about it. One I left sobbing.” She says one doctor in LA even told her: “‘You’re so pretty. What do you have to be depressed about?’” after learning that she was on an SSRI. While the doctor turned down Abby’s request to perform the surgery, she did prescribe Abby “positive mirror exercises”.
The r/childfree subReddit, where resources for sterilisation options are shared, is replete with similar stories of women who are denied these surgeries because they claim to be told they’re too young or because of their doctor’s personal beliefs on elective sterilisation.
Concerns against sterilisation are not to be summarily dismissed without conversation. The history of sterilisation in the United States is fraught with a shameful record of medical misconduct. In the early 20th century, tens of thousands of Americans were forcibly sterilised under the mission of “eugenics,” with Black women making up the largest proportion of these victims. Even now, over thirty states have laws allowing the forced sterilisation of people with disabilities or who are incarcerated. And while many patients find elective sterilisation an empowering step in a crucial battle for body autonomy, medical professionals still grapple with their role in protecting patients from what they may consider to be an irreversible mistake, acting as an ethical conduit of beneficial caregiving.
“OB-GYNs have seen people who do regret the surgeries and perhaps are trying to protect their patients from that sadness, especially because we do have alternative options like the IUD and the Nexplanon,” Dr. Haydanek says. She goes on to disclose, however, that there may be another, more misogynistic component to the high percentage of physicians unwilling to perform sterilisations: “The paternalistic thinking that we know what’s best for a patient, which doesn’t really respect the patient’s autonomy.”
Like Dr. Haydanek surmises, many doctors who deny younger patients the surgery point to the most recent study that suggests around 28 percent of patients who get tubal ligations or bilateral salpingectomies will eventually regret them. But some doctors have their own rules for deeming who they will or won’t perform these surgeries on.
Dr. Haydanek performs tubal ligations and other sterilisation surgeries frequently in her own practice, and says many women seek out because of her neutral stance on elective sterilisations. “I think it’s every patient’s right to make their own decision,” she explains. “It’s our job as a surgeon to inform the patient of risks of the surgery and less permanent alternative options. I tell patients, ‘Five percent of people will regret this and try to pursue IVF to have a biological child, and IVF is very expensive.’ That’s part of my job of disclosing the risks, but not to gatekeep it from them.”
In early 2022, Dr. Haydanek noticed the growing trend among TikTok users looking for resources on elective sterilisation. She began sharing resources on her TikTok page @pagingdrfran and compiling a list of gynaecologists across the country who self-submitted their names. The list, which she linked in her bio, went viral the day that Roe v. Wade was overturned. Dr. Haydanek has since become a formidable resource on TikTok, accumulating over 217k followers. Her list has since grown to include over 1500 gynaecologists willing to perform tubal ligations and other elective sterilisation surgeries.
While Abby had her surgery prior to the overturn of Roe v. Wade, she says “the only way I could describe it was I felt like I had just crossed some sort of sick finish line, just in time, and was watching everybody behind me just get stuck in quicksand.” Dr. Diana N. Contreras, chief healthcare officer of Planned Parenthood, says the site experienced more than a 2200 percent increase in traffic seeking information about sterilisation options on the day of the Dobbs decision. Abby found a similar rise in interest on her channel: “I felt this kind of selfish relief for myself and a lot of worry for the other people who had not been able to get this done yet and were still searching.”
Since then, Abby’s videos have gone from being more light-hearted confessionals to enacting an urgent duty to share resources to women who understand there might be a timeline to getting the surgery done.
Many young women who are experimenting with a child-free lifestyle are not even yet at the age where they would realistically be having children. Will the powerful churning of TikTok trends influence a generation of young women to make a decision they one day regret? Or perhaps our hostile climate is the real influencer, with family life appearing quite different in fifty years time.