Now Playing on Social Media: Sterilization and Millennial Hopelessness

Millennials are hopeless—but not in the way Boomers may think. 

Literally, the Millennial generation seems to be one without hope for the future. At least, that is the message my generation is sending by its low rate of marriage, and most especially, its low rate of childbearing–with some Millennials (and even younger Zennials, the micro-generation between Millennials and Gen Z) going to extremes to ensure they never have children.

It’s no secret that Millennials, broadly defined as the generation born between 1981 and 1996, are having fewer children than previous generations. The reasons given for their desires to remain “child-free” vary, but fall broadly into concerns about the costs of raising children, and the fears of bringing children into uncertain times, with special concern for the effects of climate change. Tokophobia, the pathological fear of pregnancy and childbirth, is also on the rise, fueled in part by horror stories shared on social media—at least according to one expert. Case-in-point: “I know far too much about pregnancy and childbirth to feel comfortable about anyone ever getting pregnant anymore,” says Rachel Diamond, a vocal, child-free advocate on TikTok, who has shared her sterilization journey with followers and in the New York Post. “I feel like I’m just watching people get into an unsafe situation, especially in the U.S.”  

Diamond is one voice among a growing, vocal movement of young women who have sought, or who are currently seeking out, sterilization as their birth control method of choice. Some of these women opt for a tubal ligation, whereby the two fallopian tubes are cut, so as to prevent an egg released by the ovaries from traveling down the reproductive tract in order to be fertilized. Others seek out a bilateral salpingectomy, where the two fallopian tubes are completely removed. A hysterectomy (removal of the uterus) with or without an accompanying bilateral oophorectomy (removal of the ovaries) is another sterilizing procedure, but because it is riskier than the other available sterilization procedures, the American College of Obstetricians & Gynecologists (ACOG) says that it is “medically and ethically unadvisable when the end goal is the provision of sterilization and not to safeguard the pregnancy or to treat disease.” Like a bilateral salpingectomy, a hysterectomy is a permanently sterilizing procedure; tubal ligation can sometimes be reversed, but results vary depending on a number of factors. 

Because the successful reversal of a tubal ligation is not a guarantee, women are often counseled to consider sterilization as a permanent form of birth control, although they are perhfaps given false hope that, should they decide to reverse course somewhere down the line, in vitro fertilization (IVF) will be an available avenue by which they may still become biological mothers. (In reality, while IVF success rates have improved over the years, undergoing IVF is still not a guarantee that one will become a mother, aside from the ethical issues, invasiveness of the procedure, and expense). And, when all else fails, morally problematic gestational surrogacy may also be in the back of some women’s minds as a possible fallback in the event of regret, especially with its increasing use by high-profile individuals and as more states legalize the process. 

Broadcasting on TikTok

It is difficult to find concrete evidence that the number of young women seeking sterilization is meaningfully rising. CDC data from the past several years indicates that while sterilization is the most popular birth control of choice among American women, rates are holding steady, and most women seeking sterilization tend to be older. Even so, young women like Rachel Diamond, who chronicle their attempts to find doctors willing to perform the procedure, have been achieving viral fame on social media outlets like Instagram and TikTok. The popularity of their accounts indicates, perhaps, that there are even more women who are thinking about sterilization, even if they haven’t talked their doctors into it yet. 

That latter point is a main theme of these sterilization chronicles: young women intentionally seek out doctors who are willing to sterilize them. On TikTok, sterilization-seekers frequently vent their frustrations at being turned away time and time again by doctors who tell them they are too young to make such a permanent decision regarding their fertility—a charge sterilization-seeking women find paternalistic and unnecessarily restrictive. “'Oh, you’re gonna change your mind, you’re gonna find a partner who wants kids,’ which is what every childfree person ever has always heard,” says TikTokker KT (@kt_vic), who then proceeds to talk about discovering a Reddit thread with a list of “pro-choice sterilization doctors in every state,” and reveals that she’s sitting outside her pre-op appointment for her long-awaited appointment to get her “tubes tied.” Followers and commenters are frequently sympathetic, echoing variations on the theme of “your body, your choice,” even if they themselves say they wouldn’t consider having the procedure done. 

Many women have been made to endure the risks and side effects of hormonal birth control, and it has clearly left a sour taste in their mouths when it comes to their fertility. 

Some have pointed out that the legality of the procedure alone should bind doctors into providing sterilization, regardless of their personal beliefs or concerns that patients may later come to regret it. But no doubt, the doctors refusing to sterilize young women know that regret is not a minor factor to dismiss. The most commonly cited study on sterilization regret concludes that about 20% of women younger than 30 at their time of sterilization tend to say they regret their decision at a follow-up interview 14 years later. More recent research indicates that number could even be slightly higher. Put another way, at least 1 in 5 young women who undergo sterilization may someday wish to become a (biological) mother and will have to cope with the reality that it is impossible, by her own design.

Disabling a Functioning System

Beyond the emotional and mental health implications of regret, there is now also evidence to suggest that some women experience heavy bleeding, pelvic pain, and cycle irregularity after undergoing a tubal ligation. The phenomenon is becoming well-known enough to have acquired a name: Post-Tubal Ligation Syndrome (PTLS). 

One common thread I noticed while researching the voices of young women seeking sterilization was a shared history of painful periods, and frustration with the trial-and-error process of various birth control methods prescribed to both treat their gynecological issues and prevent pregnancy. 

“I have PCOS, so my reproductive system tries to kill me once a month, or more” says TikTokker and sterilization-seeker Katie G (@thegiacobra). “Giving birth and having a child is my literal worst nightmare. And my doctors know that.” 

One wonders what kind of relationship women like Katie G., who says she is currently on two forms of birth control, would have with their fertility if they had not spent an entire lifetime battling against it. If women like Katie had access to restorative reproductive care, for example, which can treat the root causes of painful, irregular periods, would they be less willing to do away with their fertility entirely? Instead, many have been made to endure the risks and side effects of hormonal birth control, and it has clearly left a sour taste in their mouths when it comes to their fertility. 

While I hope these women do not seek out sterilization in the hopes that it will alleviate their painful cycles (and that doctors quickly disabuse them of this notion), recent high-profile stories of actresses such as Lena Dunham and Amy Schumer undergoing hysterectomies to treat endometriosis may have some women wondering if doing away with their fertility might solve all of their fertility-related problems. Sadly, even a hysterectomy is not a guarantee of alleviation from one’s endometriosis. 

Imagine, then, the frustration of a young woman—with or without prior menstrual issues—who undergoes sterilization to then experience PTLS as a result. Furthermore, a healthy, regular period is essential for the health and development of the entire female body—not simply a woman’s reproductive system. If there is a possibility that tubal ligations could be disrupting young women’s cycles, it could be to the detriment of their overall health. 

Which Came First?

As someone who has struggled with both heavy, painful periods and accompanying infertility in the past, it was extraordinarily difficult to fight against the negative feelings that I was somehow responsible for my plight—despite having done nothing to intentionally alter my fertility. It was equally difficult to maintain the hope that my husband and I might someday overcome our struggle to conceive. 

Which brings us back to the hopelessness of my generation. After all, hope is what children represent—what they have always represented. 

Getting married and having children is a vote cast in favor of a brighter future; an investment made in bringing about that brighter future. And while creating a better tomorrow is not the sole purview of parents, there is a unique interest in making the world a safer, more loving, fairer place when one’s offspring will inherit it. On the other side of the coin, a society that does not want children is one that has given into the despair that the world is a terrible place and will never get better—a society that believes that people are the problem. 

We’re told that Millennials are “lonely, burned out, and depressed.” When we consider our generation’s childlessness and the growing popularity of early sterilization among younger generations, we must ask ourselves whether it is a cause or a symptom of our hopelessness. 

Grace Emily Stark is a writer, editor, and speaker with published work in multiple outlets, including Natural Womanhood, where she is the Editor. She is a current Ramsey Institute Fellow at the Center for Bioethics & Culture, and a former Novak Alumni Fund Journalism fellowship recipient. Grace holds a M.A. in Bioethics & Health Policy from Loyola University Chicago, and a B.S. in Healthcare Policy from Georgetown University. 

Editor’s Note: The opinions expressed in this article are those of the author and do not necessarily reflect the official policy or views of the Institute for Family Studies.