Leah Spasova spent years attempting to secure a procedure to block her fallopian tubes. A psychologist by profession, Spasova found herself locked in a struggle with the National Health Service (NHS), repeatedly denied the right to permanent sterilization. The resolution came through a formal challenge to the health ombudsman.
Spasova eventually won her case, but the victory highlighted the tension in British healthcare between a patient’s desire for bodily autonomy and the institutional criteria used to grant or deny permanent contraception. Her case has become a catalyst for a broader examination of whether the barriers women face—ranging from funding refusals to rigid eligibility requirements—constitute a double standard when compared to the access granted to men.
A diverging path in permanent contraception
The disparity in access is not merely anecdotal; it is reflected in the data. In 2024-25, the number of female sterilizations performed stood at 10,793. This figure represents a 22% decrease compared to a decade ago. In contrast, vasectomies have seen a steady climb, with 26,385 procedures carried out in the same period—a 16% increase year on year.
This statistical divergence shows a contrast in trends for female and male permanent birth control. For those attempting to navigate the NHS, the experience often depends on where they live and which GP they encounter, creating what practitioners describe as a postcode lottery
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Charlotte Glynn, a research and innovation nurse at the British Pregnancy Advisory Service, notes that the procedure is frequently not treated as essential. This classification often means that women rarely reach the top of waiting lists for the procedure.
The cost of institutional gatekeeping
The barriers to access are often framed as protective measures, with some arguing that tighter controls are necessary due to the permanence of the procedure, its relative medical risk, and the possibility of future patient regret. However, critics argue that these concerns are applied inconsistently across genders.
Glynn points to a recurring pattern where women are dismissed based on age, regardless of their life circumstances or the number of children they already have. She describes the case of one patient who requested a sterilization referral from her GP three times. Despite having two or three children, the patient was told she was too young
because she was under 30.
“We had one patient who had asked her GP for a sterilisation referral three times. She already had two or three children but was under 30, so was told she was too young. She later became pregnant and had an abortion. Some women feel more empowered after that experience to go back and insist they do not want more children.” Charlotte Glynn, research and innovation nurse at the British Pregnancy Advisory Service
This sequence of events—denial of sterilization followed by an unintended pregnancy and abortion—underscores the practical consequences of medical gatekeeping. Glynn highlights this specific instance to illustrate the impact of institutional decisions on a patient’s reproductive journey.
Medical misogyny and the autonomy debate
The tension over sterilization access is not just about medical risk, but about the underlying philosophy of care. Glynn asserts that the tendency to question women’s decisions in a way that men are not questioned is a symptom of a deeper systemic issue.
“It is a form of medical misogyny,” Glynn said. “Women are often seen as primarily defined by childbearing and reproduction.” Charlotte Glynn, research and innovation nurse at the British Pregnancy Advisory Service
From this perspective, the insistence on alternative contraceptives—such as pills or patches—ignores the physical and psychological toll these methods can take. Glynn notes that many women struggle with the side-effects of hormonal contraception and that the cost of multiple unintended pregnancies also carries a significant burden.
However, not all experts agree that a systemic disparity exists. Anna Glasier, an emeritus professor at the University of Edinburgh, argues that women actually have the same level of access as men. Glasier contends that the issues regarding the irreversibility of the procedure apply equally to both sexes and that long waiting times for vasectomies are a nationwide issue in the UK.
Glasier also suggests that the availability of long-acting reversible contraception (LARC) provides women with a viable alternative that is as effective as sterilization but can be reversed. These methods, she notes, can work for 8 to 12 years, offering a middle ground between temporary contraception and permanent surgery.
Regarding the clinical comparison, Glynn notes that while some argue the procedure is riskier than a vasectomy, the priority should be respecting a woman’s informed decision if she has been given the correct information and expresses a clear desire for the surgery.
The precedent for systemic change
The victory of Leah Spasova via the health ombudsman demonstrates that individual autonomy can be successfully defended when institutional criteria are challenged. The case brings attention to how patients are managed within the system when seeking permanent contraception.
The debate now centers on whether the NHS should shift its approach from one of gatekeeping to one of informed consent. If a patient is provided with the necessary information regarding the risks and the permanence of the procedure, the argument for institutional refusal weakens.
The current state of reproductive care in the UK reflects a broader struggle over who controls the female body: the patient or the provider. As Glynn suggests, the need for improvement extends across many areas of women’s health, where accessibility remains uneven and trust in patient autonomy is lacking.
The implication of Spasova’s case is clear: the existing barriers to sterilization are not invisible, and they are increasingly being challenged. For thousands of women currently on waiting lists or facing denials from their GPs, the ombudsman’s decision provides a potential pathway to reclaim authority over their own reproductive futures.
