One Woman's Battle for Sterilisation Exposes a Wider Crisis in Women's Healthcare

One Woman's Fight Puts Female Sterilisation Under the Spotlight

When Leah Spasova, a psychologist, was refused sterilisation on the NHS, she didn't quietly accept the decision. She escalated her case to the health ombudsman — and won. Her victory has sparked a broader national conversation about whether women are being treated fairly when they seek permanent contraception, and whether their right to make decisions about their own bodies is being genuinely respected.

Spasova had spent years attempting to access a procedure that blocks the fallopian tubes to prevent pregnancy. Her experience, far from being unique, reflects a pattern that many women across the UK report: repeated refusals, age-related restrictions, and a sense that medical professionals simply don't trust them to know their own minds.

The Numbers Tell a Troubling Story

Statistics from 2024–25 reveal a striking imbalance. Female sterilisations carried out on the NHS totalled 10,793 — a 22% drop compared with a decade ago. In the same period, vasectomies numbered 26,385, actually rising 16% year on year. Critics argue this gap is not merely a reflection of patient preference, but a symptom of systemic inequality embedded in how women's reproductive choices are treated by the healthcare system.

'Women Are Not Being Trusted to Decide'

Charlotte Glynn, a research and innovation nurse at the British Pregnancy Advisory Service, works in abortion care and sees the consequences of this inequality regularly.

"We see many women who have been placed on waiting lists for sterilisation or have requested it but been told they are too young," she said. "There is a real problem with women not being trusted to make decisions about their own bodies."

Glynn acknowledged the argument that sterilisation carries slightly more surgical risk than a vasectomy, but maintained that informed consent should be the deciding factor. "If a woman is given the right information and that is what she wants, that should be respected," she said.

She also challenged the notion that cost savings justify blocking access. Unintended pregnancies carry significant financial and personal costs, she noted, and many women already struggle with the side effects of hormonal contraceptives like the pill or patch.

A Postcode Lottery — and a Form of Medical Misogyny

Perhaps most strikingly, Glynn drew a direct comparison between how men and women are treated when requesting sterilisation. "Men are not questioned in the same way," she said. "It is a form of medical misogyny. Women are often seen as primarily defined by their capacity to bear children."

Access, she explained, functions as a postcode lottery. The procedure is frequently not classified as essential, meaning women rarely reach the top of NHS waiting lists. She recalled one patient who had requested a sterilisation referral from her GP three times, despite already having children, only to be repeatedly turned away for being under 30. The woman later experienced an unintended pregnancy and had an abortion before finally being taken seriously.

"We should be making sterilisation more accessible," Glynn concluded. "Like many areas of women's health, this needs improvement."

The Case for Caution: Regret Is a Real Factor

Not everyone agrees that access barriers are inherently unjust. Anna Glasier, emeritus professor at the University of Edinburgh, argues that the conversation is more nuanced than critics suggest.

"The issues with the procedure being effectively irreversible are the same for both men and women, and there are long waiting times for vasectomy throughout the UK," she said, pushing back against the idea that women face uniquely unfair treatment.

Glasier pointed to a significant advantage women have that men do not: access to highly effective long-acting reversible contraception (LARC). Devices such as the IUD, hormonal coil, or implant can provide contraceptive protection for 8 to 12 years while remaining fully reversible. For men, the realistic alternatives are limited to condoms or withdrawal.

Regret Rates Demand Honest Conversation

Glasier also raised the issue of regret — a factor she believes justifies a degree of caution, particularly with younger patients.

"Some studies suggest regret rates could be as high as 20%, or one in five," she noted. "The data also shows that regret is more likely in younger patients, and particularly when sterilisation is carried out soon after a pregnancy — for example, within a year of having a baby."

This, she argued, is precisely why clinicians often encourage long-acting reversible contraception first. It keeps options open without permanently closing any doors.

A Question of Autonomy vs. Medical Responsibility

The tension at the heart of this debate is not easily resolved. On one side stands the principle of bodily autonomy — the idea that a woman who is fully informed and has made a considered decision deserves to have that decision honoured. On the other sits a legitimate clinical duty of care, informed by evidence that permanent decisions made at certain life stages are sometimes later regretted.

What Leah Spasova's case makes undeniably clear is that the current system is inconsistent, often opaque, and leaves many women feeling dismissed. Whether the solution lies in improved access, better patient education, or a formal rethinking of eligibility criteria, the status quo is increasingly difficult to defend.