The NHS and female sterilisation

The case of a woman denied sterilisation by the NHS has brought the procedure, and the alleged double standards that hamper access to it, back into the spotlight.

Leah Spasova, a psychologist from Oxford, spent 10 years trying to access the procedure, but her funding request was turned down over “concerns regarding potential regret and cost-effectiveness”, said the BBC. As the same NHS body regularly funds vasectomies without using potential regret as grounds for rejection, Spasova complained to the health ombudsman.

Last Friday, the ombudsman ruled that a policy citing the “risk of regret” as grounds to refuse funding was “unfair” to women.

What did the ombudsman say?

The Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board’s approach was “unfair, inconsistent, and based on subjective reasoning”, the ombudsman ruled. And Spasova’s case “is not an isolated one”.

A committee responsible for recommendations across six integrated care boards in the southeast reviewed the female sterilisation policy after Spasova’s complaint. It recommended that regret or the availability of other contraception should no longer be used as grounds for refusal, and that all patients who meet the critiera can access female sterilisation.

“Rejecting my application for sterilisation on the basis of regret means they were taking on liability for my feelings,” said Spasova. Policies like this are “damaging for women’s healthcare” and “absolutely discriminatory”.

How does female sterilisation work?

Sterilisation is a procedure that blocks, seals or cuts the fallopian tubes, to prevent eggs from reaching the uterus. Also known as tubal ligation (“getting your tubes tied”), it’s usually performed under general anaesthetic via keyhole surgery, with about a week of recovery. Although complex procedures do exist to reverse it, they typically have a success rate of between 50-70% and aren’t usually available on the NHS.

Female sterilisation is the most common contraceptive method used worldwide, according to the UN. In 2019, nearly 24% of women using contraception relied on sterilisation – but it’s far more prevalent in Asia and Latin America than Europe.

A 2022 analysis of Dutch women puts the rate of regret at about 10.5%, compared with 5.1% of men who regret vasectomies. But the rate of regret is nearly twice as high among women under the age of 30: about 20%. NHS clinical guidance says sterilisation should be available for women, with counselling to address the risk of regret.

Is it available on the NHS?

Sterilisation for both men and women is organised by local integrated care boards (ICBs), as part of NHS contraception services. Most ICBs routinely fund both male and female procedures, subject to certain criteria being met, but some told The i Paper that “vasectomy is encouraged or preferred over female sterilisation”. Others “go one step further and restrict funding for female sterilisation”, said the paper. In those areas, women have to submit an individual funding request for approval.

In 2024-2025, the NHS carried out nearly 11,000 sterilisations: a year-on-year increase of 2%. But the long-term trend is downward: a 22% decrease in a decade. In contrast, the number of vasectomies performed in 2024-25 was 16% higher than in 2023-24.

What are the barriers to access?

Critics argue that the stricter eligibility criteria for women seeking sterilisation “amount to unequal treatment compared with men seeking vasectomies”, said The Guardian. But others say “tighter controls reflect legitimate medical concerns”, including the risks associated with a more invasive procedure.

Patients seeking sterilisation have been “told they are too young”, said Charlotte Glynn of the British Pregnancy Advisory Service. “There is a real problem with women not being trusted to make decisions about their own bodies,” she said. It is “a form of medical misogyny”, especially when many women “struggle with the side-effects of contraceptive pills”.

Many women are told they “might change their mind” or are asked what their partners think about their decision, Annabel Sowemimo, a consultant in sexual and reproductive health, told The i Paper. Tubal ligation also costs more than vasectomies as it requires “multiple members of staff and time in theatre”. This is compounded by the “obscene” waiting times for gynaecology treatment, she said. Life-threatening conditions are prioritised, while patients waiting for sterilisation are advised to use contraceptives instead.