Does a woman have to be 25 years old, married, have at least one son and one daughter, and have her husband's consent to get a tubal ligation? No, that's not true: Requirements for surgical sterilization for women (and men, too) can vary greatly depending on many things such as national and local laws, the individual doctor's ethical preferences, a private hospital's policy or the type of insurance coverage. There is not one simple list of qualifying boxes to check that will apply to every woman.
The claim originated in a post (archived here) posted on Facebook on September 19, 2018. It read:
Guy at work yesterday: if I was a female I'd get my tubes tied at 18 and do my own thing
Me: *uncontrollable laughter*
Him: how old do you have to be to get that anyway?
Me: you must be 25, married, and have at least one son and one daughter, and your husband must agree
Him: WHAT!??!!?! You mean you can't just go and snip it up if you dont want kids?
Me: nope
Other guy at work: wtf I could walk in right now and get a vasectomy though
Me: That's because men are in control of their own bodies 🙃Thank you for coming to my TedTalk, this is Women's Rights 101 🙃🙃🙃
This is what the post looked like on Facebook at the time of writing:
(Source: Facebook screenshot taken on Wed Jul 29 13:36:47 2020 UTC)
Restrictions do exist that could prevent a woman from obtaining sterilization surgery at the time she requests it, but the specific collection of requirements listed in the post is not reflective of the situation in the U.S. in 2020. The requirement to have consent of the spouse has been considered unconstitutional since the 1970s.
There can be confusion when people encounter a restriction but do not realize where it is coming from. A private Catholic hospital may refuse to do any elective sterilizations. A specific doctor may set the minimum age at 25. A federally funded health insurance policy will insist on a 30-day waiting period after signing the consent form. A mother may tell her adult daughter that husband's consent was required back when she was born.
In the 1970s there were several court cases questioning the then-standard requirement for a woman to have her husband's consent for her own sterilization surgery. One case recorded by the Family Planning/ Population Reporter (here) (archived here) from June 1977, is titled, "Arkansas: hospital ordered to stop requiring spousal consent to wife's sterilization:"
A U.S. district court judge has ordered the University of Arkansas Medical Center to discontinue its policy of requiring a married woman to have her husband's written consent to sterilization. Additionally, this March 30 the order of Judge Terry Shell requires the hospital to post a notice in a prominent place indicating that the consent of a married woman's husband is not a necessary prerequisite to the performance of surgical sterilization procedures. Department of Health, Education, and Welfare regulations governing the use of federal funds for sterilization require that the woman be fully informed of the nature of a sterilization, give her informed, written consent, and wait 72 hours between the time of consent and the procedure. Judge Schell indicated that he would retain jurisdiction in the case for 6 months to ensure the hospital's compliance with his order. The case arose when the hospital refused to sterilize a woman following the birth of her infant by Caesarean section unless her estranged husband gave his consent.
In April of 2017, the ethics committee of the American College of Obstetricians and Gynecologists issued a set of revised ethical recommendations titled, "Sterilization of Women: Ethical Issues and Considerations"(here)(archived here). In regards to young women who do not have any children, it said this:
It is ethically permissible to perform a requested sterilization in nulliparous women and young women who do not wish to have children. A request for sterilization in a young woman without children should not automatically trigger a mental health consultation. Although physicians understandably wish to avoid precipitating sterilization regret in women, they should avoid paternalism as well.
In 2002 EngenderHealth published an update to its 1985 factbook, with the new editio titled, "Contraceptive Sterilization: Global Issues and Trends" (here)(archived here) The individual chapters can be downloaded as a PDF and Chapter 4 (here)(archived here) is the one relevant to describing the way sterilization laws vary around the world, as well as how these laws have changed over time. Contained there is a very compact list of rules by country. This is how the United States is described:
Most developed countries allow voluntary sterilization for contraceptive purposes. In the United States, competent adults (those who are capable of making an informed decision) can undergo sterilization legally in all 50 states and all territories. Federally funded voluntary sterilization is subject to restrictions on age (a minimum of 21 years) and a waiting period (30 days), but none related to marital status, parity, or spousal consent. While states are allowed to create their own guidelines for state-funded sterilization, some simply follow federal guidelines. No legal restrictions associated with parity, marital status, or a waiting period apply to privately funded services.
A restriction that was not mentioned in the original post but is mentioned in the caption above is a 30-day waiting period after a woman (or man) signs an informed consent form for a surgical sterilization. This restriction applies to people in the U.S. who have federally funded health insurance such as Medicaid, or insurance through the military or the Indian Health Service. This requirement applies no matter which state is their home.
The U.S. Department of Health and Human Services' "CONSENT FOR STERILIZATION" form (here)(archived here) also stipulates that the person must be 21 years old to consent.
I understand that the operation will not be done until at least 30 days after I sign this form. I understand that I can change my mind at any time and that my decision at any time not to be sterilized will not result in the withholding of any benefits or medical services provided by federally funded programs. I am at least 21 years of age and was born on: Date
There are doctors who question if the 30-day waiting period is not more harmful than helpful. An author manuscript was published in the New England Journal of Medicine January 9, 2014, titled, "Medicaid Policy on Sterilization -- Anachronistic or Still Relevant?" (here)(archived here), included this description of findings of another study:
Preventing women from obtaining a desired sterilization puts them at high risk for unintended pregnancy. In one study, 47% of women who requested but did not receive a postpartum sterilization became pregnant during the first year after delivery -- over twice the rate of pregnancies in women who did not request sterilization.
