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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Coming up in about 20 minutes, we'll have that call-in for people in your 90s and 100s on what midterm election issue is the most important to you. We've been going up the generations all week and today we conclude with people in your 90s and above, invited to call in in about 20 minutes to tell us what election issue is important to you in 2022.

Maybe you want to tell us who's the first president you ever voted for, or what the most important election issue in your lifetime has been, but if you're in your 90s or 100 or above, that call-in for you in about 20 minutes.

First, for people maybe a little bit younger, yet another facet of post-Roe America emerging now is that more people are seeking vasectomies or trying to get their tubes tied, the procedure medically known as tubal ligation. The Washington Post reports that although official data isn't available, OB-GYNs across the country say they've seen a rise in the number of requests for the tubal ligation procedure.

There's a really informative story in The Washington Post that spotlights a few patient experiences, including the pushback that some people are receiving from doctors when they show up for their initial consultations. Other OB-GYNs have been educating people about tubal ligation on social media and that, of course, is for people who can't get pregnant. There are also vasectomies for those who could impregnate. More people are reportedly asking about those too.

We'll talk now to the author of The Washington Post story Meena Venkataramanan, Washington Post staff reporter. Hi, Meena. Welcome to WNYC.

Meena Venkataramanan: Hi, Brian. Thanks so much for having me.

Brian Lehrer: Let's start with the definition. What is tubal ligation? I suppose this is Anatomy 101.

Meena Venkataramanan: Sure. Tubal sterilization, also known as tubal ligation, is a form of permanent sterilization that involves cutting or what's known as, informally, tying the fallopian tubes so that they aren't able to be the site of fertilization between sperm and an egg. One common form of this is the bilateral salpingectomy, which is actually becoming more common in the field and is the complete removal of the fallopian tubes so that they're not there in the first place.

Brian Lehrer: You said permanent. This is not reversible in any form?

Meena Venkataramanan: Certain variants of the procedure are reversible, but the bilateral salpingectomy, which is the most common these days is not reversible because there are no tubes left to even really put back together. There are forms of the procedure that are technically reversible, but those procedures to reverse the tubal ligation can be very costly and doctors often encourage patients to treat the procedure as permanent because it is so difficult to reverse it and the success rate can really vary.

Brian Lehrer: You write in your story that even though official data isn't available, OB-GYNs say they've noticed a spike in the number of requests. Has that increase been spread evenly across the country, if you can tell, or is it concentrated in states where abortion restrictions have already gone into effect?

Meena Venkataramanan: For my story, I primarily spoke to people in swing states and in states where abortion restrictions have gone into effect or are going into effect. From what I heard from those doctors, they have anecdotally seen an increase in the number of patients, including Dawn Bingham in South Carolina, who said she's seen an increase, as well as Pam Parker in the Rio Grande Valley of Texas.

These are two states in which abortion has been restricted or is expected to be restricted severely and these are areas in which OB-GYNs are reporting an increase. We also have OB-GYNs in New York, which is a fairly progressive state when it comes to statewide abortion. Fran Haydanek and Amy Lasky both practice there and they've also said they've seen an increase anecdotally in the number of requests.

Brian Lehrer: Your story gets into some of the pushback patients are receiving from doctors when they express interest in getting their tubes tied. What has that pushback looked like or sounded like at least to the folks you spoke to in your reporting?

Meena Venkataramanan: The patients I spoke to have reported facing pushback especially if they're younger. If they're in their 20s and they don't already have children, these patients have said it's been pretty hard to be able to get approved for the procedure and that's because they're often asked questions such as, are you sure you want the procedure? Are you sure you won't regret it or change your mind later, and even what happens if you find the perfect man who wants to have children with you later on?

These are all questions that they've told me they've been asked and some of them have been denied the procedure entirely because it's really up to a doctor's discretion whether or not they can give this procedure to someone and their personal comfort level with it.

Brian Lehrer: Oh, it's ultimately up to the doctor, not the patient?

Meena Venkataramanan: It seems, according to these patients, that their own sense of bodily autonomy is not being respected and that the doctors are the ones who are really evaluating their fitness for the procedure as opposed to their own level of certainty. While the American College of Obstetricians and Gynecologists recommends that doctors avoid being paternalistic and ultimately affirm the own reproductive autonomy of these patients, it seems that, according to my reporting, a lot of these patients are simply saying, "Well, that's not the case. These doctors have acted in very paternalistic ways."

Brian Lehrer: Does the professional organization recommend any kinds of lines of conversation when somebody who's young, you mentioned people in their 20s, come in and ask for this kind of permanent sterilization? It is a big deal for a relatively young person to make an irreversible decision not to have kids, right?

Meena Venkataramanan: Yes. The American College of Obstetricians and Gynecologists has put together those recommendations, Brian, in terms of emphasizing the permanence of the procedure and discussing with patients other reversible contraceptive options such as IUDs and birth control pills, and in what they call appropriate cases, even discussing the sterilization of male partners, such as vasectomies, as an option with what they call fewer risks and greater efficacy than tubal sterilization.

In addition to this, ACOG, the organization, suggests that doctors also encourage patients to really think about the permanence of the procedure and not act in a way that seems to assume what the patient wants.

Brian Lehrer: Listeners, we have time for some calls on this. Have you, post-Roe especially, tried to get a tubal ligation, help us report this story, or a vasectomy? What have your experiences been? Did you face pushback from your position and OB-GY-- from your physician, if I didn't say that word right.

OB-GYNs, you physicians, we want to hear from you too. Are more people coming to your offices asking about this procedure? What do you do if they're very young, like in their 20s and are asking for it? What kind of conversation do you think is appropriate? Would you ever just refuse to perform it? Should you even be allowed to do that even if you're uncomfortable? 212-433-WNYC, 212-433-9692, or tweet @BrianLehrer with Meena Venkataramanan, Washington Post staff reporter who wrote this up.

You also, kind of on the other side of the physician question, report on some who've taken it upon themselves to educate folks on social media. How are those doctors spreading what kinds of messages and what are they emphasizing?

Meena Venkataramanan: The push to educate people on social media has come from both doctors and patients. I'll start with doctors. They have been creating Twitter lists and TikToks and even Google Forms lists of gynecologists who will perform the procedure on people regardless of age and the number of children they have. Dr. Fran Haydanek in New York actually put that list together.

In addition, she's been creating TikToks, one of which has received around 4.7 million views, when I last checked, about the procedure and that came out right after the Supreme Court decision. Amy Lasky, also in New York, has put together a Twitter thread.

In terms of patients, we've seen Reddit pages. Sarah Sulkowski, one of the patients I interviewed, has started an Ask Me Anything on Reddit, where patients can ask questions or prospective patients can ask questions about the procedure. There has been a lot of social media traction around the procedure.

Brian Lehrer: There have also been other stories in the news about an increase in the number of patients seeking vasectomies too. Yours is more about tubal ligation. I wonder if childless men seeking vasectomies are getting the same pushback as women seeking tubal ligation. Any impression based on your reporting?

Meena Venkataramanan: Yes. Actually about two months ago right after this decision came out, I did report a story on the increase in vasectomies and vasectomy requests that urologists and other physicians were seeing among men and other patients who wanted to get the procedure after the Supreme Court decision. Anecdotally, what I found in that story is that these patients were really not facing much pushback, they said it was a very simple consultation and an office procedure.

Even some of the younger men in their twenties whom I spoke to were just really saying that it was something that doctors would very briefly ask them about and then just go ahead and perform the office procedure. It seems as if there really is some disparity in the ways in which patients seeking tubals are treated compared to patients seeking vasectomies.

Brian Lehrer: Gale in Manhattan who says he's a healthcare provider. Gale, thank you so much for calling in. You're on WNYC.

Gale: Hi, it's Gale of the females' Gale.

Brian Lehrer: Sorry about that, Gale.

Gale: No worry at all. I'm well, well aware, having been in the field for over 50 years, about women and people of other races also being treated differently than white affluent men and women. However, I'm really concerned about a rush to language that says pushback or paternalistic when the provider has to really assure informed consent. I love this conversation, but there's a very large informed consent and psychological testing that's even given for people that want a gastric bypass to make sure they will not suffer consequences from even having the procedure in the future.

I just want to give balanced view to the difficulties for providers in this tenuous time with all these issues. I applaud you for this guest and what's been said, thanks so much.

Brian Lehrer: Thank you very much. Did you hear from many healthcare providers like Gale in the course of your reporting?

Meena Venkataramanan: I did hear that it is important to really give a nod to the history of forced sterilizations and the lack of informed consent. That's historically been a problem in the United States when sterilizing people, so I do really appreciate Gale's comment about ensuring there is informed consent around this procedure. It seems that a lot of wealthier white patients and patients who are not deemed to have certain mental illnesses are often treated better by providers, according to my reporting, than others who were once classified as mentally unfit.

I do think that it is important according to both patients and doctors to really be aware of the United States' history of forced sterilization and ensure that informed consent is being given before the procedure is performed.

Brian Lehrer: Does your reporting indicate that the people seeking tubal ligation or vasectomies are more affluent? I can imagine that either procedure might be cost-prohibitive for a lot of people. I don't know what's covered by insurance.

Meena Venkataramanan: In terms of insurance coverage, the Affordable Care Act mandates the coverage of tubal sterilizations, but that's not the case for vasectomies. Although the ACA does mandate tubal sterilization coverage, the costs can really vary and sometimes without insurance, a patient can pay up to $6,000, and vasectomies are only a fraction of that cost, around $600. It does seem that cost can be prohibitive according to patients.

One other important thing to note is that if a patient is using Medicaid to cover this procedure, they have to wait at least 30 days from the time of giving informed consent in order to have the procedure. If they want to have it right after they deliver, they must have already provided consent 30 days before delivery. That can also be a barrier for some people, and they have to be at least 21 years old if they're using Medicaid.

Brian Lehrer: Getting on the phones, we're getting a lot of stories of people who some time ago were denied vasectomies or tubal ligations when they'd first sought to get them. Let's hear a couple of those stories. Joy in Avila Beach, California, you're on WNYC. Hi, Joy.

Joy: Good morning, Brian. Yes, in my 20s, I was denied a tubal ligation. Repeated requests, every month when I went to the clinic for my birth control pills, "Please tie my tubes." "No, no, no, you'll change your mind." I'll be 70 in two months and I'm still very proud to be child-free by choice.

Brian Lehrer: What did the healthcare providers tell you at that time? What was their language if you recall?

Joy: Well, it was condescending. It was all women there, so you couldn't really say exactly paternalistic, but it was so infuriating that they knew me better than I knew myself.

Brian Lehrer: Joy, thank you very much. Adam in Nyack, you're on WNYC. Hi, Adam.

Adam: Hi. In my 20s, I've known since I was about 20, 21 years old that I wanted a vasectomy, that I didn't want kids, and every time I moved and saw a new doctor, I would ask about the possibility of getting vasectomy and I was always denied. I was told that no doctor would perform a vasectomy on someone under the age of 30 because of liability reasons. They didn't want to be sued if I decided 5, 10 years later that I wanted to have kids.

Brian Lehrer: Huh. Interesting. Do you ever hear that one, Meena, like where a doctor was worried that they would be held liable for doing something that some court might deem irresponsible?

Meena Venkataramanan: In terms of liability, there's no national legal requirement in terms of the age for a tubal sterilization. My reporting about vasectomies didn't go into legal liability about performing a vasectomy on a young patient, but I'm sure there are stories out there as the one we just heard about younger patients also being faced with skepticism and doubt when they are seeking a vasectomy.

Some of the doctors I spoke to for my vasectomy story that came out in late June did also mention that they do have more intense discussions with younger patients who come in for the procedure just to ensure that they're completely sure about it as well.

Brian Lehrer: Daniel in Queens, you're on WNYC. Hi, Daniel.

Daniel: Hi. Longtime listener, first time caller. I just wanted to talk about my own experience with a vasectomy. I got a vasectomy shortly after my twins were cleared for autism and I felt very content. When I went for my initial consultation, I was told that I would have to wait 30 days to get my vasectomy. I was also encouraged to talk about it with my wife, and so I talked to my wife about it although she didn't want to talk about it, and she was avoiding it.

I eventually asked her how she felt about it the night before the procedure. I need to preface that. My wife had a very difficult time with birth control, especially after we started having children, and I was really doing it for her so that she could recover and not have to deal with birth control.

Brian Lehrer: Back to you to-- and we're going to run out of time in the segment, but, Daniel, did you tell our screener that you're in the process of trying to get your vasectomy reversed?

Daniel: Yes.

Brian Lehrer: Medically, are you finding that possible?

Daniel: Well, I'm now interested in getting a reversal because I basically found out that my wife was actually planning to divorce me, and that's why she wasn't talking to me about the vasectomy. Now I'm in the process of looking into the reversal.

Brian Lehrer: Regardless of the complexities of your relationship, whatever they are, what does the doctor say about reversal?

Daniel: I just feel like people should really think hard about getting a vasectomy and that you need to do it for yourself, not for somebody else.

Brian Lehrer: Daniel, thank you very much. I'm going to leave it there for time. I appreciate it. One more. Maxine in Brooklyn, you're on WNYC. Hi, Maxine. We have about a minute for you.

Maxine: Hi, Brian. Thank you so much for covering this subject. It's a subject very close to my heart. I spent 10 years making a film called to Kill or Not to Kid about deciding whether or not to have children and actually followed a young woman compared to a man trying to get a tubal ligation and how much easier it was for the man to get a vasectomy than it was for young women. I love this guy you've just had on the radio earlier talking about the hormone issues that women often get, and yet trying to get sterilization is so hard.

Brian Lehrer: Maxine, thank you very much. Does this remind you at all, Meena, about the stuff that's in the news about what trans people go through when they ask for HRT, or gender-affirming surgeries and are denied, like informed consent is important but at the end of the day, people need to make their own decisions, even if they turn out later to be mistakes in their view?

Meena Venkataramanan: Yes. Brian, I think there's definitely overlap between the two. A couple of the patients I spoke to for my story actually identify outside the gender binary, one is non-binary, the other is bigender. Both of them did say tubal sterilizations in a way for them were gender-affirming procedures. They did discuss being able to have that autonomy and agency over removing their fallopian tubes, and that being able to affirm their gender identity. In some ways, I do think that there is overlap between hormone replacement therapy and other gender-affirming procedures as well as tubal sterilizations.

Brian Lehrer: We do have a caller who I'm not going to have time for on the air but who says she had a tubal ligation and still got pregnant, and then had to have an abortion. Have you ever heard a story like that?

Meena Venkataramanan: That does happen sometimes according to my reporting. There is a risk. It's a rare phenomenon, but there's a risk of an ectopic pregnancy and sometimes that does lead to abortion. There is a low chance but there is also a 99.5% success rate of tubal sterilizations according to the doctors I spoke to.

Brian Lehrer: Meena Venkataramanan, Washington Post staff reporter who wrote about people now post-Roe seeking vasectomies and tubal ligation. Thank you so much for sharing your reporting with us.

Meena Venkataramanan: Thank you, Brian, for having me.

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