A woman who was denied a permanent form of birth control on the NHS because of fears she might regret it, while men were allowed contraceptive procedures, has won her case with the health ombudsman.
Background of the Case
Leah Spasova, a psychologist from Oxfordshire, spent a decade fighting to obtain female sterilisation at her local trust. This procedure blocks or seals the fallopian tubes to prevent pregnancy. By contrast, men can undergo a vasectomy, a minor outpatient procedure that stops sperm from being released.
She was refused the sterilisation procedure on the NHS, with her local trust citing concerns about potential regret and cost-effectiveness. Spasova challenged the decision, taking her complaint to the parliamentary and health service ombudsman, which hears complaints about the NHS in England.
Ombudsman's Ruling
The ombudsman issued a critical ruling against the Buckinghamshire, Oxfordshire and Berkshire West integrated care board (ICB), which had denied her funding. The investigation found that the ICB had denied women NHS funding based on the risk of 'regret', a criterion not applied to men seeking vasectomies. The ombudsman concluded the policy was unfair, inconsistent and based on subjective reasoning, and that women were not being given the same opportunity as men to make informed decisions about their own bodies.
Paula Sussex, the ombudsman, said: 'The issue highlighted in Leah's case about the commissioning and managing of services by ICBs is not an isolated one. We are concerned that there may be similar wider problems affecting multiple areas of healthcare, and that the system is not consistently meeting people's needs.'
Impact and Changes
After Spasova's complaint, the advisory committee recognised the equality issues and recommended that female sterilisation should be funded. Regret and the availability of alternative contraception are no longer considered valid grounds for refusal.
Spasova said: 'I have been enquiring about sterilisation for 10 years and was just passed back and forth between services. Rejecting my application on the basis of regret means they were taking responsibility for my feelings. Someone else is making decisions about your body based on criteria you can't even see.'
She added: 'I was probably about 22 when I realised children weren't for me. It's a lifestyle, it's forever work. It's a lifetime commitment. I understood quite young that I didn't want that level of anxiety in my life and that I didn't want to make that commitment.'
Despite the ruling, Spasova noted that barriers remain. She said: 'As of today, I see that my local NHS trust is expanding access for men who seek vasectomies, making it even easier to self-refer on the NHS budget without even a GP referral. Yet even with the latest female sterilisation policy, women are required to prove they've tried long-acting contraception to show that it's unsuitable for them.'
A spokesperson for the ICB said: 'NHS Thames Valley accepts the findings of the parliamentary and health service ombudsman regarding historical decision-making in this case. Since that time, NHS Thames Valley has introduced a new policy to ensure that patients who meet the criteria are able to access female sterilisation.'
