Voluntary Sterilization

Though neither doctors nor their patients like to talk about it, voluntary sterilization has become one of the most popular operations in the U.S. Statistics pile up behind a veil of silence, but best estimates are that 1,500,000 Americans have already been sterilized and 100,000 more are operated on each year.

The procedure is the surest of all methods of birth control, but it got off to a bad start because it has often been equated with involuntary operations performed on mental defectives and criminals (TIME, Nov. 13). It has also been confused with castration.* Sterilization, however, does not involve removal of any part of the sex glands or organs, and has no effect on physical capacity for intercourse. It simply makes it impossible for the woman's egg or the man's sperm to travel its normal pathway.

Despite the present popularity of the voluntary operations, many Americans still have not heard of them, and of those who have, most--including a surprising number of doctors--think they are illegal. But only three states (Connecticut, Kansas and Utah) require medical justification. The other 47 states have no such requirement. The chief proponent of the operations, the Association for Voluntary Sterilization, argues that they are legal provided that they are "for the protection and in the best interest of the patient's well-being."

Major & Minor. Sterilization of a woman, or salpingectomy, is admittedly major surgery, but Dr. Alan F. Guttmacher, president of Planned Parenthood-World Population, contends that it is no more difficult or dangerous than an appendectomy. It must be done in a hospital under general anesthesia. Through an abdominal incision, a gynecological surgeon cuts both Fallopian tubes and ties off the separated ends. After that there is no way for an egg to pass from the ovary to the womb.

The operation is often done immediately after childbirth. It is technically easier then, and more convenient because the patient is already in the hospital. Surgeons' fees average around $200. Increasing use of contraceptive pills among women who can afford them may tend to cut down female sterilization. But there is no pill for men.

The male operation, or vasectomy, is a minor operation--quicker, simpler and cheaper. It is usually done in a doctor's office, under local anesthesia. The surgeon makes a small incision in one side of the scrotum and pulls out a length of the vas deferens, the tube through which spermatozoa pass from the testis on the way to the urethra. He cuts out about half an inch of the tube and ties off both ends, and repeats the operation on the other side. It can all be done in about 15 minutes, for an average fee of $75. The man can go back to work the next day, and resume sexual relations in a week or two.

If a couple should later want more children, or if either partner remarries and wants children, the chances for de-sterilization range from 50% to 80%. The surgeon performs a reverse operation and sews the tubes back together.

Appalachia Campaign. The popularity of voluntary sterilization was not generally suspected until 1959, when a study by the University of Michigan's Survey Research Center showed that in one out of every ten couples of childbearing age, either husband or wife had been sterilized. The survey sampling ranged through all social strata. The only population group showing markedly lower-than-average rate was the Roman Catholics, to whom sterilization is forbidden by papal encyclical and decree.

Proponents of voluntary sterilizatie" are not so much propagandizing for the operation as they are trying to break down prejudices against it. One area where there is an active campaign t. promote it is Appalachia, where men who have been unemployed for years continue to father unwanted children. The Voluntary Sterilization group has set up a pilot project for several countries,* with a $25,000 grant from Jesse Hartman, a Manhattan real estate man. In its first six months, this plan has signed up scores of men and women, with 115 operations already completed or approved at an average cost of $195 for women and $40 for men. Charge to the patients: nothing.

* Castration in men consists of removing the testicles, in women of removing the ovaries. In both it is a beneficial and desirable procedure to slow the ravages of cancer of the prostate, breast or uterus if the growths are of a type that is stimulated by sex hormones.

* India, now adding 10 million annually to its population, is aiming at sterilization of 2,500,000 men a year. As an inducement, Indian states offer bounties ranging from $1.60 to $6.30.

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