Ombudsman rules against NHS trust after psychologist denied sterilisation
A psychologist who was refused NHS funding for sterilisation has won her case before the health ombudsman, exposing what critics describe as a system that treats women’s reproductive choices differently from men’s. Leah Spasova spent a decade seeking a tubal occlusion procedure — an operation to block the fallopian tubes — but was repeatedly turned down by the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (ICB).
The ICB argued that the procedure was not cost-effective and that Spasova might later regret the decision. Yet the Parliamentary and Health Service Ombudsman found that the same trust routinely funded vasectomies for men without using the risk of regret as a reason for refusal. In its ruling, the ombudsman described the approach as “unfair and inconsistent” and noted that the ICB had failed to explain its decision-making process properly. Following Spasova’s complaint, a review of female sterilisation policy across six ICBs in the South East recommended that the procedure should now be funded, and that neither potential regret nor the availability of other contraception should be used as grounds for withholding it. The ombudsman also warned that similar inconsistencies might exist elsewhere in the NHS.
Wider debate over access and medical misogyny
The case has reignited a long-running argument about whether women face disproportionate barriers to permanent contraception. In 2024-25, NHS hospitals in England carried out 10,793 female sterilisations — a 22% fall from a decade ago and only a 2% increase on the previous year. Over the same period, 26,385 vasectomies were performed, a 16% rise year on year and 41% higher than pre-pandemic levels. The gap has widened sharply: in 2014-15 there were 13,858 female sterilisations, while vasectomies have recovered from a low of around 10,880 in 2015-16 to exceed 26,000.
Critics argue that the disparity reflects a deeper problem. Charlotte Glynn, a research and innovation nurse at the British Pregnancy Advisory Service (BPAS), said the NHS operates a “postcode lottery” for sterilisation, with some women unable to get referrals because of age restrictions or local funding rules. “Working in abortion care, we see many women who have been placed on waiting lists for sterilisation or have requested it but been told they are too young. There is a real problem with women not being trusted to make decisions about their own bodies,” she said. Glynn described the differential treatment as “a form of medical misogyny” — a term used to describe systemic sexism in UK healthcare that can lead to symptoms being dismissed, longer diagnostic times, and less autonomy over treatment choices. A House of Lords research paper in 2021 cited studies showing poorer health outcomes for women, while the Women and Equalities Committee has warned of “structural and deeply embedded” sexism in the health service. The UK government has since launched a Women’s Health Strategy for England aimed at addressing these issues.
Glynn pointed out that male patients requesting vasectomies are rarely questioned in the same way. “Women are often seen as primarily defined by childbearing and reproduction,” she said. She recounted the case of a patient under 30 who had asked her GP for a sterilisation referral three times but was refused because of her age. After an unplanned pregnancy and abortion, the woman felt “more empowered” to insist on the procedure. “Multiple unintended pregnancies also carry a cost,” Glynn added, noting that in 2010 unintended pregnancies cost the NHS an estimated £193.2 million in England alone, with one study calculating an average total cost of £2,922 per unintended pregnancy when healthcare and social costs are included.
Glynn acknowledged that female sterilisation is a more invasive and riskier procedure than vasectomy, but argued that this should not override a woman’s informed choice. “If a woman is given the right information to make an informed decision and that is what she wants, that should be respected. Many women struggle with the side-effects of contraceptive pills and patches,” she said.
Expert opinions: a question of alternatives and regret
However, not all experts agree that the system discriminates against women. Professor Anna Glasier, an emeritus professor at the University of Edinburgh who has researched fertility control, argued that women do have the same access as men, but face different medical realities. “The issues with the procedure being effectively irreversible are the same for both men and women, and there are long waiting times for vasectomy throughout the UK,” she said.
Glasier pointed out that for women, long-acting reversible contraceptives (LARCs) — such as intrauterine devices, hormonal coils and implants — offer an alternative that is over 99% effective and can last between three and ten years. “For women there is a good alternative — it makes sense to offer it to them, while for men the only other methods are condoms or withdrawal,” she said. LARCs are generally available free on the NHS and, unlike sterilisation, are instantly reversible once removed. NHS guidelines already recommend counselling on LARCs before referring a woman for sterilisation, and extra care is taken with patients under 30, those without children, or those who have recently given birth.
Glasier also cited the risk of regret as a legitimate medical concern. “It’s challenging because many of the women requesting sterilisation are relatively young, and we know there is a measurable rate of regret. Some studies suggest it could be as high as 20%, or one in five. The data also shows that regret is more likely in younger patients, and particularly when sterilisation is carried out soon after a pregnancy — for example, within a year of having a baby. That’s one reason why LARCs are often encouraged, as they keep options open.” She added that eligibility criteria for vasectomy similarly include counselling and a recognition that men under 30 are more likely to regret the procedure.
Glynn from BPAS rejected the idea that regret should be used to restrict access. “We should be making sterilisation more accessible. Like many areas of women’s health, this needs improvement,” she said. The ombudsman’s ruling in Spasova’s case has already prompted a policy shift in the South East, but questions remain over whether other ICBs will follow suit — and whether the NHS will treat women’s requests for permanent contraception with the same seriousness as men’s.