More Child-Free Women Are Getting Sterilized — Here's What to Know

Ashley Manta knew she didn't want kids as early as her teen years. Now 38, she recalls feeling "very resistant" to her parents' suggestions that she find babysitting jobs while growing up.

"Even as I got older, after college and grad school, when I looked at my friends who had kids, they always seemed exhausted, stressed, and financially strapped," Manta says. "Kids are expensive! I'd rather spend my money on growing my business, traveling, and saving for the future."

Manta is far from alone. The subreddit r/childfree has 1.5 million members, and there's a sterilization subreddit with 17,000 people dedicated to discussing permanent birth control options like getting their fallopian tubes removed (called a bilateral salpingectomy). In fact, Manta had this exact surgery in 2024. Now, she's able to permanently enjoy the child-free life she envisioned for herself.

Experts Featured in This Article

Franziska Haydanek, DO, FACOG, is a board-certified ob-gyn at Rochester Regional Health.

What Is a Bilateral Salpingectomy?

A bilateral salpingectomy (called a "bisalp" for short) is the removal of both fallopian tubes, which are structures that allow eggs to travel from the ovaries to the uterus, according to Johns Hopkins Medicine. Because fertilization happens in the fallopian tubes when an egg and sperm meet, fully removing both fallopian tubes ensures a pregnancy can't occur.

A bisalp is different than a tubal ligation, which is the technical term for "getting your tubes tied." A tubal ligation involves tying your fallopian tubes to prevent the sperm and egg from meeting — not entirely removing them — per Johns Hopkins Medicine.

"In regards to anyone wanting to be sterilized, for the most part, now, most surgeons are doing the bilateral salpingectomy because it's the least likely to fail — we've removed the entire tube, so there's nothing we can reattach," says Franziska Haydanek, DO, FACOG, a board-certified ob-gyn at Rochester Regional Health. On that note, Dr. Haydanek emphasizes this surgery isn't reversible.

Removing both fallopian tubes can also lower your risk of ovarian cancer, because many instances of ovarian cancer likely start as small tumors in the fallopian tubes ― not in the ovaries — according to the National Cancer Institute.

This minimally invasive surgery involves undergoing anesthesia, Dr. Haydanek explains. Once you're under, the surgeon makes an incision in your abdomen and inserts a thin tube that has a light and video camera (called a laparoscope). They use the laparoscope to help guide surgical tools that remove both fallopian tubes.

Complication rates for bisalps are low, Dr. Haydanek says, but there are always risks associated with any type of surgery where you're given general anesthesia. Additionally, Dr. Haydanek says that if you have unknown endometriosis or pelvic inflammatory disease, those can increase the risk of complications during the bisalp surgery.

The recovery process of a bisalp is fairly quick, according to Dr. Hydenek. "Most of my patients take about a week off from work, she says. "The first couple of days, patients are going to feel sore — they're going to feel like they did 1,000 sit-ups . . . but by the end of the week, my patients say, for the most part, they feel right back to normal."

Why Are More Women Seeking Out Permanent Forms of Birth Control?

The current political landscape is a major reason that child-free people like Manta are seeking out permanent forms of birth control. "When Roe v. Wade was overturned by the Dobbs decision in 2022, I knew I needed to start looking into more permanent forms of birth control," Manta says. "Around the same time, I started considering what it would look like to live in a state other than California, specifically Texas where I have family, and I knew I would never feel comfortable living in an anti-choice state if there was any possibility of my becoming pregnant."

Similarly, Jordan Smith, 32, cites the 2024 presidential election as the impetus for scheduling a bisalp, which she had in March 2025. "I knew I didn't want kids in college. Before that, it just wasn't something I was super interested in, but in college I started to realize it wasn't something you had to do," she says. "After the results of the 2024 election, I got more serious about permanent birth control. Before that, I'd had an IUD. After I got my first IUD replaced, I also realized that I did not want to do that for the rest of my life."

Anne Langdon Elrod, 27, has known she doesn't want to have children for several years. In 2019, she says, she came to the realization that American society often falls short in supporting expectant and working mothers. "I've known women who have faced life-threatening complications during childbirth, including hemorrhaging and emergency hysterectomies," Langdon Elrod says. "And a coworker of mine explained to me that pregnancy is considered a preexisting condition, and many women are unaware they need to enroll in such insurance before becoming pregnant — unless their employer offers a group plan. Hearing her perspective opened my eyes to the complexities women face when planning for motherhood."

The Process for Getting Approved for a Bisalp

The Affordable Care Act (ACA) requires most insurance plans to cover female sterilization surgery without any out-of-pocket costs to patients, according to the National Women's Law Center. However, Dr. Haydanek points out that some insurances may not cover things like the anesthesia portion or the operating room time. "I always encourage my patients to call their insurance ahead of time to verify what they're going to cover, just to make sure it's not a big financial loss for them."

If you have Medicaid or state insurance, they do require surgeons to wait 30 days before doing the surgery, according to Dr. Haydanek. "Historically, there were patients who were sterilized against their will, especially patients who had state insurance, so that's kind of supposed to be a safety mechanism, although I believe it's a little bit of a barrier still," she says.

Additionally, "there's the barrier of finding a doctor who will do it, especially for younger and child-free patients, which is the whole reason I started my list of doctors who can help you, because, you know, paternalism is alive and well," Dr. Haydanek says. "As doctors, we need to be able to trust our patients. If you're already child-free, the risk of regret is quite low. We're slowly moving in those directions I feel, but still, there's going to be doctors who feel like the risks don't outweigh the benefits. But in the end, I always say that's not so much for us to decide when it comes to something like a tubal sterilization."

For Manta, it took more than a year from when she first asked her gynecologist about the surgery to finally getting it done in October 2024. "I knew I specifically wanted my tubes to be removed, rather than a tubal ligation, because it reduces ovarian cancer risk," she says. "My gynecologist dismissed the research I provided and said that he would do a tubal ligation, but not remove the tubes. I changed gynecologists when I moved, and my new gynecologist was very supportive. She said she prefers to remove the tubes for the precise reason I wanted one — ovarian cancer risk reduction. I had to wait 30 days to schedule the procedure even after she approved it due to Medicare rules, but the surgery was covered 100 percent."

For Smith, the process was a lot easier. "I floated the idea by my provider and she jumped on it right away and explained the bilateral salpingectomy," she says. "I had to sign some consent forms and the hospital ran it through my insurance, which was approved. I was actually shocked that it was so easy because I know for a lot of people it's not."

Over the course of a year, Langdon Elrod tried to get both her ob-gyn and her primary care physician to take her request for sterilization seriously. They both refused, she says, citing the fact that she was under 30 and child-free. Eventually, she reached out to a new ob-gyn whom she found via Reddit post (someone had compiled a list of doctors, organized by state, who were willing to perform tubal ligations without age or parental status restrictions).

"It felt like a small miracle," Langdon Elrod says. "With the upcoming election and fears of stricter reproductive laws, I reached out to a female doctor in Alabama. The response was swift but daunting — her next available appointment for new patients was May 2025. I felt crushed, the weight of uncertainty pressing down harder. But just days later, she called back. If her surgical schedule allowed, she could see me earlier. I jumped at the opportunity and secured an appointment for October 2024."

She brought her husband to the appointment with her, "fully aware that some providers — especially in the South — might care about his opinion more than mine." But that ended up not being necessary. "[The doctor] greeted me warmly and said, 'If you've gotten this far, I know you've done your research. Ask me anything.' I nearly cried from relief. No judgment. No assumptions. Just support," Langdon Elrod says. She finally got her surgery in December 2024.

The Future of Bisalps

From 2000 to 2013, there was a 77 percent increase in the number of bisalps performed, according to a 2016 research letter in the American Journal of Obstetrics and Gynecology. And, according to the National Center for Health Statistics, female sterilization was the second-most common form of contraceptive method from 2011-2013 (after the birth control pill).

Even with increased restrictions around women's healthcare as of late, Dr. Haydanek doesn't see bisalps going away as a popular choice for child-free women. "I think as we continue to talk about it as an option, we'll continue to find the benefits of the full tube removal," she says.

Manta's post-bisalp experience has been positive. "Everyone close to me has been incredibly supportive of my choice to be child-free and my decision to have my tubes removed," Manta says. "I even had a virtual 'sterilization shower' — because why should only pregnant people have a party? — and got lots of sweet gifts from friends all over the country."

Smith has had a similar experience. "People who already know that I want to be child-free are supportive of it," she says. "I haven't had anything negative said to me, but I'm sure there are people who don't agree with my decision or don't understand it."

Langdon Elrod still wrestles with moments of doubt about her decision, but is working through it with her therapist. "I remind myself regularly that I still have options — IVF or adoption, should I choose them. That knowledge eases my mind," she says. "The power of choice is mine. My decision isn't dictated by politics or public opinion but by what is best for me. Having control over my body is liberating. It's a freedom I fought for and one I'll continue to protect."

Danielle Zickl is a freelance writer who has 10 years of experience covering fitness, health, and nutrition. You can find her work here on PS, and in many other publications including Self, Well+Good, Runner's World, Outside Run, Peloton, Women's Health, and Men's Fitness.