Contraception by Financial slavery

This week, there was a unique scenario of, a 32-year-old woman who came to the hospital for an elective cesarean section delivery and asked her obstetrician to conduct a permanent family planning method commonly known as Bilateral Tubal Ligation (BTL) during the cesarean delivery. The uncommon social issues that surround the case are that this was her second birth. Her first pregnancy was with her former boyfriend about eight years ago when she was 24 years old, and in school; they were not married and he moved on and is probably married to someone else somewhere. And then, the antecedent pregnancy, the responsible man is a family man elsewhere with five children and desires not to marry her or father another child with her. With no commitment for marriage, support from the father to this about-to-be-born baby, is quite unassured. Perhaps that explains the mother’s decision that she can’t have her next pregnancy with a third man, whom she fears could also refuse to hold up to his responsibilities. She has decided to play God and play it safe for herself and for her children. In her most sober moment, she asked the doctor to  permanently stop her from producing children via conventional means

This woman explained how she stays in the village, with no job, and already having a 4^th mouth to feed, her old mother. I mean many contraceptive options exist, and she was provided with longer-term and reliable options, including implants, injectable depo contraceptives as well as intra-uterine device (IUD) which can last up to 10 years, with 99% protection from pregnancy, but she remained undeterred from her choice to permanently cease childbearing.

3 years ago, I met a young lady, 33. She had had 3 children from her first marriage, and had requested for a BTL, which had been performed since the couple had decided on not having more children. 2 years after the procedure was done, the marriage ended for various reasons. She later met and fell in love with this man who was early into his 50s. Never married, no kids, and  was ready to have a family. They got married, he took in all her 3 kids, and he wanted 2 of their own. This lady had come to the hospital to have her BTL reversed. An expensive surgery was performed by a senior obstetrician, and now she was hoping for a miracle. BTL reversal has a 30 to 60% chance of returning fertility if the procedure was successful. The chances are however lower in women aged 35 and above. This was probably the same chance or lower, this patient stood at saving this second marriage.

I can’t help but think about the existing similarities and differences between these two women. This new woman knows her options, and the consequences, but is perhaps held by the financial limitation, and this is a strong one. Many women and couples, even when gainfully employed or doing well financially, can’t afford more than 2 children. When you look at taking care of children’s health care, social life, education, and factoring in one’s own needs, many couples might never afford to give their children the kind of life their parents gave them. And I find it painful that finances have to dictate our current lives to certain heights while giving us future regret.

This is one of those moments where as a doctor, you want to respect the patient’s autonomy, but also can’t help the fact that a lot could play differently for her as it did for the other patient from 3 years ago.

But who is to blame? Do we blame poverty? Is this another thing we will blame on the current government? The law and medical ethics tell us to stick to patient autonomy, but what does humanity say? And what would be your decision as a health worker?

Happy Living, Happy surviving !

Violah & Asiphas