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Survey: Healthcare staff attitudes affect access to sterilisation

Accessing the procedure in Finland can take up to two years.

Eläinlääkäri Suvi Heinola tekee bokserinartulle sterilointileikkausta, jossa poistetaan munasarjat.
Ever since 2016, the number of male sterilisations has been consistently higher than female ones. Image: Sanna Savela / YLE
Yle News

An Yle poll has found that attitudes toward sterilisation among healthcare workers can make it easier or harder for patients to access the procedure.

Yle received some 500 responses to questions about the smoothness of applying for and getting sterilised.

Around two thirds of the respondents were women and a third were men, while one percent identified as non-binary.

All genders reported having had both good and bad experiences with sterilisation providers.

Almost ten percent of respondents said they had not received the procedure despite requesting it. Eight percent reported they were currently waiting for the operation while some 78 percent had already undergone it.

Multiple appointments and tedious questions

One doctor is often enough if one opts for the procedure through a private sector healthcare provider. However, before a public provider can carry out the surgery, it must be approved by at least two healthcare professionals.

Mother-of-two and former hormonal contraceptive user Niina Laitio told Yle that her first meeting was a success.

"I was listened to. My reasons for getting the procedure were good, and the doctor said that I had clearly thought it through," Laitio said, adding that the first doctor had only asked the necessary questions and went through the basic facts during their appointment.

Laitio's second meeting at the women's clinic took a different turn, however. The second doctor asked Laitio, who already had a long-term partner, whether she had thought of the possibility that she would someday fall in love with a man who wanted children.

"I thought it was downright outrageous, because I myself make the decision about my body and no one else - not my current or possible future partner," Laitio told Yle, adding that "everyone has the right to sexuality, and I think it's a terrible starting point that if no contraception works, then you just have to accept it and live in fear until your last days of fertility."

The responses to Yle's poll show that Laitio is far from alone.

"Hormonal contraception methods have caused me a lot of side effects. At the age of 36, I got cancer and had to get rid of hormonal contraception. I went to the reception with confidence and waited for that magical moment to finally arrive when I would get the contraceptive I wanted," Piia from Pieksämäki told Yle, adding however that "the doctor ruled that I'm too young and the IUD I had at the time was working well so they wouldn't remove it, let alone refer me to a sterlisation doctor. This time I burst into tears when I closed the door behind me."

Piia also told Yle that she finally had the procedure at the age of 39, after nine years of constant battling with healthcare professionals and various contraception methods.

Vaasa resident Paul Ulfvensin also spoke to Yle about his experience. The 31-year-old mentioned having had an easy time getting the green light, however he was met with inappropriate comments once at the operating table.

Ulfvens reported overhearing a nurse say that the patient must already have a lot of children since he was getting the procedure.

"I thought wow, how unprofessional," Ulfvens said, before explaining his decision to remain child-free to the nurse in question.

He added how unfortunate the same comment could have been for someone who was getting sterilised due to medical complications.

Number of ligations decreased

The number of female sterilisations, or tubal ligations, has decreased substantially throughout the early 2000s.

Male sterilisations on the other hand, have increased. Of all sterilisations performed in 2021 in Finland, some 66 percent were vasectomies. In comparison, only 17 percent of sterilisations were performed on men in 2000.

Women's Clinic professor Oskari Ikäheimo told Yle that negative experiences with getting the procedure may be due to the fact that the surgery is not too common.

"With the number of sterilisations decreasing, few professionals deal with such cases on a regular basis. They will therefore not have developed their own, routine way of informing patients about the matter."

The gynaecologist added that the law is clear both about the requirements to access sterilisation and guidelines around providing all the necessary information.

"Under no circumstances should the attitudes of the healthcare staff affect the process. At the same time, there can be misunderstandings and differing interpretations: if a professional asks whether the patient understands that this is a permanent solution, they might feel attacked," Heikinheimo said.

Sterilisation is not covered by the treatment guarantee, meaning that receiving the surgery could take up to more than two years.

Heikinheimo told Yle he would like to see operations take place within six months of applying. Staff shortages and the healthcare bottleneck caused by the pandemic however make this unlikely.

"Contraception should be available all year round - is it really even an option if a person of fertile age has to wait two years for it? Of course at the same time, people with severe illnesses requiring urgent treatment should always come first," the doctor said.

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