There are a number of ways to avoid pregnancy. Condoms, oral pills and coils all give varying degrees of success (and side effects), but there’s one almost certain, albeit permanent, way to prevent it: getting your tubes tied. In Malta, however, women can’t get the procedure unless they cough up thousands at a private clinic.
Tubal ligation, also known as getting your tubes tied or tube sterilisation is a permanent form of birth control. During the procedure, the fallopian tubes are cut, tied or blocked, preventing an egg from travelling to the ovaries and thereby causing pregnancy.
It can be done at any time including after childbirth and most cannot be reversed. While it doesn’t protect against sexually transmitted diseases, studies show it may decrease the chances of ovarian cancer.
There may be different reasons for wanting the procedure, formally known as tubal ligation. Still, women in Malta can’t get it done in national hospital for contraceptive reasons.
Lovin Malta spoke to women who are forced to cough up thousands to get their tubes tied at a private clinic or not have the procedure done at all.
Celina Galea is 23 years old and has just recently become a mother of three. She’s looking to get tubal ligation done but can’t afford the hefty €3,000 price tag.
“Even if I could afford it, I know I’ll be written off as too young to get it done.”
When asked if she’s considered less permeant contraceptives like oral pills, she says there are times when she couldn’t afford them either.
“Why do I have to take contraceptives if I know what I want to do with my body?” she said.
Kelsey Coleiro is another mother of the same age and the same number of children.
“I know for certain that I’m done having children. I can’t take the pill because the side effects I got for years were horrible,” she said.
“Abortion is illegal and getting your tubes tied is nearly impossible or costs an arm and a leg. How can we say that we value women’s lives and believe they have control of their bodies?”
Coleiro believes we should trust women to make their own decisions when it comes to family planning, especially in a country where abortion is completely illegal.
“I’m still amazed at the fact that abortion costs less than a form of contraceptive. Why it is easier to find a surgeon to have a breast augmentation than a surgeon that performs tubal ligation?” she added
Another 51-year-old woman, who prefers to be anonymous, said she got her tubes tied when she was 23 years old. It cost approximately €1,000.
“My dad chipped in… and I don’t regret having it. Today I’m blessed with two grown-up kids.”
According to a practitioner at Mater Dei, tubal ligation cannot be offered unless it’s required for medical reasons.
“Within the government’s health service, at the obstetricians and gynaecologists department, we cannot offer tubal ligation for contraceptive reasons unless it’s required for specific medical reasons,” they told Lovin Malta.
The reasons include if the patient has had three cesarian births or serious mental health issues making another pregnancy dangerous to mental health.
In fact, no contraceptive methods, like pills, rings, progestogen injections, coils, implants or sterilisation are available under national health services.
“They can be discussed and advice can be given, but the actual device or medication or surgical procedure is not offered,” they added.
Like tubal ligation, there are exceptions to the rule.
“The exceptions are when a coil is used to treat heavy menstrual bleeding, when sterilisation is for medically indicated reasons, or when the progestogen injection is supplied to vulnerable or disadvantaged patients on a case by case, named patient basis.”
In their opinion, tubal ligation should be up to women to make an informed decision with their doctor.
“If it is their informed choice, then I think it should be respected. But they need to know there are other excellent longterm reversible contraceptive options and that tubal ligation is a surgical procedure with operative and anaesthetic risks,” the doctor said.
“It is considered permanent and not reversible, but if it is their choice, in an ideal world that should be respected.”
In general, providing free contraception to women irrespective of their income could be a huge step.
“Especially in a country where abortion is illegal and there are a number of teenage pregnancies, we need to give women the means to protect themselves,” the doctor added.
Adding contraceptives to the government’s essential medicine list could ensure that they aren’t constantly out of stock and ensure every woman has access to them. This could be one incentive to update Malta’s decade-old sexual health policy.
Do you think tubal ligation should be offered for contraceptive reasons?