Woman refused NHS sterilisation because she 'might regret it'

Getty/BongkarnThanyakij

By Erin Dean

A woman was “unfairly” denied funding by an NHS organisation for sterilisation as she “might regret it”, while vasectomies were routinely provided, the health ombudsman has said.

Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (ICB) rejected the request as it did not at the time routinely fund the procedure and cited risk of regret as a reason for declining.

Male sterilisation was routinely funded by the board for eligible men - and did not use regret as a reason for rejection, the ombudsman found.

The investigation into Leah Spasova’s experience concluded that the ICB’s approach was “unfair, inconsistent, and based on subjective reasoning”. 

Paula Sussex, parliamentary and health service 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 we have concerns that the system is not consistently meeting people’s needs and is letting patients down.”

Tubal ligation is a surgical procedure which requires general anaesthetic and takes up to 30 minutes. Vasectomies are performed under local anaesthetic in 15 to 20 minutes, and are carried out at GP surgeries, sexual health clinics or hospitals.

'Absolutely discriminatory'

The ombusdan found that the ICB did not follow non-mandatory clinical guidance which says sterilisation should be available for women and that counselling – not blanket exclusion – should address the risk of regret.

Spasova, a psychologist from Oxfordshire, had been requesting the procedure for 10 years. Her treatment was “absolutely discriminatory”, she said.

“The policy in place at the time appeared inconsistent with key principles of NHS care, did not respect the NHS Constitution, and did not align with NICE guidance around contraceptive choice.  It did not follow the widely recognised principle that clinicians provide advice, but patients ultimately make decisions about their own bodies.”

She added: “Rejecting my application for sterilisation on the basis of regret means they were taking on liability for my feelings.”

In 2024, an advisory committee was given responsibility for making policy recommendations for six ICBs across the region, including Buckinghamshire, Oxfordshire and Berkshire West. Four of those six ICBs already funded female sterilisation.  

Following Spasova’s complaint, the committee recommended that female sterilisation should be funded.

Regret or the availability of more cost-effective alternative contraception is no longer used as grounds for refusal.  

In a statement, Thames Valley ICB, which replaced Buckinghamshire, Oxfordshire and Berkshire West ICB last month, said it had since "introduced a new policy to ensure that patients who meet the criteria are able to access female sterilisation".

"As a new ICB, we are also redesigning our complaints function to ensure concerns about local services are responded to more effectively and in a timely way," it added.

‌
‌
‌
‌
‌
‌