Sexuality and Sterilization in International Reproductive Health Programs

Margaret Greene, Population Action International

Female sterilization is a significantly more invasive, costly and risky procedure than male sterilization, and is somewhat less efficacious, yet its prevalence dramatically surpasses vasectomy everywhere except in North America and Western Europe. That female sterilization has become the norm, while male sterilization is viewed with suspicion, is a clarifying moment of gender inequity. Though the profound reproductive health disparities women and men face are increasingly well documented, a comprehensive review of the factors that contribute to divergent sterilization rates is conspicuously lacking. Several gender-related factors within health systems contribute to higher levels of female sterilization: The privileging of male sexuality and virility in the reproductive health context; health system efficiencies that favor sterilization by tubal ligation at the time of delivery or abortion; and the role of health services in coercive sterilization of women who come for other services.