DAYTON, Ohio — A simple brochure, sitting in the rack at the back of church, first attracted Ruth Bushman's attention.

It asked, “Are you angry, depressed, or isolated?” Bushman was, so she took one. The brochure addressed the feelings of post-abortive women. While Bushman hadn't had an abortion, she had undergone tubal ligation, and wondered if the aftereffects of sterilization might not be similar.

Bushman, of Melrose, Minn., is one of a growing number of sterilization patients who are questioning the emotional costs of sterilization.

A report issued by the National Center for Health Statistics states that among married U.S. women aged 15 to 44, the prevalence of surgical sterilization was 41% in 1995 — almost triple the percentage in 1965.

Worldwide, tubal ligation is the No. 1 form of birth control for women over the age of 30, according to Susan J. Bucher, founder of the Coalition for Post Tubal Women. She estimated that more than 140 million women have been sterilized for birth control purposes.

Among them is Ruth Bushman. While pregnant with her second child, Ruth said she began wrestling with the possibility of sterilization. Her husband was skeptical, however.

“Earl thought it was unnatural and that I shouldn't do it,” Ruth Bushman recalled. “I didn't seek counsel because, inside, I knew I was doing something unnatural. I rushed into it.”

Their daughter, Emily, was born in 1992. Six weeks later Ruth underwent a tubal ligation. “We had a boy and a girl,” she explained, “and I was fearful that we would not be able to take care of any more children.”

Within six months, the mother started having regrets. “While breastfeeding Emily I realized that I was never going to have this experience again,” she lamented. “I experienced a loss … it was something I did, but could not undo. I entered a very dark period of my life.”

The Aftermath

Bushman said that the sterilization affected her physically, emotionally, spiritually and maritally.

“Spiritually, I had said ‘no’ to God,” she acknowledged. “I was telling him, ‘I don't trust you; I'm going to take care of this myself.’ I threw away his precious gift of fertility and felt separated from the Church.”

The sterilization affected her intimacy with her husband as well. “Mentally, there was the feeling that this was no longer what it was created to be,” Ruth Bushman said. “Something was missing. I did not feel whole.”

Medical evidence exists both for and against what has come to be known as post tubal syndrome. Post tubal syndrome is described as being brought on by the rapid decline of estrogen/progesterone hormone levels caused by the blood supply to the ovaries being damaged during surgery. Its symptoms are associated with a hormonal imbalance and can include depression, anxiety, loss of libido, and heavy, painful periods.

In a systematic review of medical literature, the medical research team G.P. Gentile, S.C. Kaufman and D.W. Helbig concluded that there were no significant increases in incidences of “post-tubal ligation syndrome.” Separate studies, however, such as those by G.R. Huggins and S.J. Sondheimer point out that a percentage of women experience gynecological or psychological problems as a result of sterilization.

While the medical research is mixed, there are many individuals who attribute their physical or emotional pain to their sterilization.

Susan Bucher doesn't need convincing about the fallout from sterilization. She described the lack of information women are given about possible side effects as the “malpractice crime of the century.”

Even organizations typically in support of contraception have recognized the potential effects of sterilization. In September the Illinois National Organization for Women's state conference unanimously passed a resolution calling on physicians to inform women of the possible hormonal side effects of tubal ligation.

Until January, Peggy Powell had answered One More Soul's sterilization-reversal hot line in Dayton, Ohio. She said that feelings of emptiness and loss of closeness to one's spouse were common occurrences among the hundreds of phone calls she received.

“So many people expressed sadness,” Power said. “They cried and grieved the loss of their fertility.”

Indeed, the National Center for Health Statistics has reported that nearly 25% of women who had a tubal ligation in 1995 expressed a desire for reversal of the operation.

Men also experience regret. Take Army Col. John Long, who had his own vasectomy reversed after seven years. He said that the feelings of regret over sterilization are “quiet, deep and slow to manifest themselves.”

“Men are told that a vasectomy is great for marriage,” Long continued. “It is snip-zip and everything is going to be sexy and wonderful. Later they discover how empty it is. It can cause tremendous hurt, and by the time men figure out the cause, it's too late.”

He added, “There's an almost uniform experience of regret … remorse comes from both spouses.”

The Bushmans looked into having the sterilization reversed, but found the cost prohibitive.

“Insurance companies pay for the sterilization,” Ruth Bushman said, “but they will not pay for the reversal.”

Bushman said she has confessed her sin and received reconciliation, but admitted that she continues to have a difficult time forgiving herself.

“I cheated my children out of brothers and sisters, and I cheated Earl and myself out of sons and daughters,” she said. “I will live with that decision until the day I die.”

The Catholic Church condemns sterilization as a means of birth control and considers it disrespectful of a person's bodily integrity. The Catechism of the Catholic Church goes so far as to list sterilization among various forms of violence to be avoided. No. 2297 reads, in part: “Except when performed for strictly therapeutic medical reasons, directly intended amputations, mutilations, and sterilizations performed on innocent persons are against the moral law.”

Although the Church, through the sacrament of reconciliation, offers hope and forgiveness to those who have been sterilized voluntarily for reasons of birth control, for some it is not enough.

“The idea of reversal popped up on my radar screen every six months,” said Long. “It just wouldn't go away.”

“One of my first calls,” recalled Powell, “was from a man who couldn't afford a reversal. I counseled him to go to confession, but he countered, ‘Yes, but if you broke a window you would say you're sorry and then you would pay to have it fixed.’ Although the Church does not require a reversal, many want to do more. There are many good doctors who as a ministry are willing to do reversals at cost. Many couples have spoken of the renewal that reversal brings to their marriage.”

Certainly, not everyone is able to obtain a reversal.

“I tell those individuals that they have received a great gift,” said Powell. “Their eyes have been opened to the truth. Many cannot see the truth, and their blindness leads to separation and divorce.”

Long and Powell are editing a book of sterilization reversal stories which will be published by One More Soul later this year.

“Reversals are a growing, but still exceptional event,” said Long. “People need to know that reversals are possible, highly successful and not as rare as you think.”

Both Powell and Long stressed that there is a need for counseling. Ruth Bushman is working with the St. Cloud Diocese's Office of Natural Family Planning to form a support group for couples dealing with the grief that accompanies sterilization.

Organizations such as One More Soul, and the Protestant groups By His Mercies and Blessed Arrows are also filling the sterilization ministry void. The latter two provide limited financial assistance to individuals unable to afford reversals.

When reversals do occur, they offer the potential for new life. Said Powell, “I was 38 when my husband had his reversal, miscarried at age 40 and had my daughter Maria at age 42.”

Tim Drake is based