A few weeks ago, TikTok posts of young Kenyan women sharing their experiences with tubal ligation, a surgical procedure where fallopian tubes are tied to prevent conception, went viral.
The women are in their 20s to 30s. They are childless. And they are happy to share their heroic stories on social media.
Commonly known as getting tubes tied, the sterilisation procedure has been the most common form of contraception, particularly among women in their 40s or those who have finished child-bearing, but it has spiked abruptly among childless 18 to 30-year-olds.
“I got my fallopian tubes tied recently. Every time I remember I am sterile, it gives me so much joy,” wrote a young woman on social media.
As women in our 20s, tubal ligation feels scary because of its permanency, yet our peers are doing it. In the social media posts, our peers explain in detail how it is done, and where it was done, free of charge. Showing the surgery marks on their stomachs, they explain that their fallopian tubes were cut or tied to prevent pregnancy for the rest of their lives.
In a conservative society, you would expect such posts under #tuballigation and #childfreebychoice to attract criticism, but the responses were overwhelmingly positive. Within a few days of posting, one of them had garnered about 1,600 comments; some congratulations, others inquiries and others testimonials from those who had already tied their tubes.
“I am 23, I want this too…,” one wrote.
The childfree movement, previously a Western phenomenon, is gaining ground in Africa where societal attitudes pose a major psychological impact on women who have no children.
Experts say that the trend for owning the ‘child-free’ label and discussing the choice of opting out of motherhood or fatherhood more openly is picking up pace. The rise of younger influencers, online communities and support groups for child-free men and women, has made the trend more relatable.
“Child-free means not wanting children and having no desire to take on the burden of parenthood. Visit our website for forums, blogs and dating,” read a banner from an Instagram Kenyan group named childfreekenya.
Role of shifting aspirations
Prof Charles Olunga, an anthropologist at the University of Nairobi says
the ability to access information about different contraceptive methods at the click of a button, along with stories from celebrities who have chosen not to have children, empowers young people to make these life-altering choices.
He adds that the rise in permanent contraception among young people is deeply connected to a shift in aspirations and empowerment.
“With access to education, greater independence, and the ability to own property, many young people, especially women, are redefining their relationship with motherhood,” he explains.
For some, the societal expectation of having children is seen as a potential roadblock to personal growth and freedom.
“Many young people today view motherhood not as a natural step in life but as something that could compromise their ambitions. There is a growing desire for freedom, whether it’s to travel, focus on careers, or avoid the interruptions of pregnancy and childbirth. The notion of permanent birth control methods like tubal ligation and vasectomy, in this context, offers a sense of control over their futures,” he says.
Cultural and religious controversy
Tubal ligation has been controversial for years. Some religions forbid procedures that result in sterilisation, including vasectomy and tubal ligation.
But young millennials and Gen Zs are questioning this aspect of religion. They argue that there is no higher being that would have planned for them to be mothers. It is a human choice and not the "Will of God."
Loice Noo, a psychologist and relationship expert, says the reasons behind the decision for younger women to opt out of motherhood can vary.
“For some, the fear of children can come from witnessing the pain and trauma of childbirth. Someone could have seen the trauma of childbirth and decided not to associate with that process,” she tells Nation Lifestyle.
Another cause, she says, is when people have lost loved ones during childbirth or seen them develop lifelong health problems afterwards.
“With that in their subconscious, if they do not go through therapy to deal with that trauma, it can affect their decision when it comes to parenthood,” she says.
Ms Noo also points to the rise in pet ownership, which plays a role in the child-less trend.“There is also the issue of the emerging trend of having alternatives for children—especially pets like dogs and cats. You see people take the best care of their animals,” she says.
Cost implications and accessibility
But as the trend gains traction, save for those doing it for free, surgery for permanent fallopian tube ties is costly. This is because tubal ligation is more complicated and it is difficult to reverse, hence more expensive than a vasectomy. In public clinics, it ranges between Sh30,000 and Sh100,000 and up to Sh300,000 or more in private hospitals.
In comparison, family planning pills and coils can cost from Sh100 to about Sh25,000, depending on the facility and duration of effectiveness.
“Tubal ligation is a more fulfilling procedure for women who want to concentrate on their careers after having children instead of worrying about birth control every other time,” Dr Esther Wanjohi, a consultant obstetrician and gynaecologist, told the Business Daily in a past interview.
Tubal ligation is a type of permanent birth control. It's also known as having your tubes tied or tubal sterilisation.
Photo credit: Shutterstock
Dr Maureen Awiti, a gynaecologist at Kenyatta National Hospital, also says there is a growing number of Kenyans choosing permanent contraception methods, such as tubal ligation and vasectomy.
“It’s unusual, as it's assumed that human beings naturally want to procreate, but modern life has brought new perspectives,” she says.
Legal framework and social stigma
If women in their 20s are getting tubal ligation, is there no legal implication that would bar a clinic from performing the procedure to one so young?
Pius Nyoike, a Nairobi-based Advocate of the High Court, explains that as long as one is of legal age—18 years— she can undertake the procedure.
“It’s an elective procedure, which should not be compulsory or dictated by anyone,” he says.
However, he notes potential legal challenges in cases where someone in a legal relationship undergoes the procedure without their partner’s knowledge, as this could lead to claims of being "short-changed."
Some experts advise that women can simply delay childbirth, rather than eliminate the option altogether. Others emphasise the need for thorough counselling before making such life-altering decisions.
“For anyone to take on that kind of decision, therapy is crucial. It helps process underlying trauma or fears,” says Ms Noo.
For example, one should know that the risks involve the probability of conceiving even after the tubes have been tied. Also, if one changes their mind later in life the procedure reversal rate is minimal.
Reversing tubal ligation requires specialised micro-surgery, which is both costly and carries a low success rate. In Kenya, according to Dr Awiti, the likelihood of a successful reversal is less than 10 percent, a statistic that highlights the permanence of the decision.
“Internationally the figures were given as about 25 percent, locally, from our studies, I don’t have a reversal of (bilateral tubal ligation) BTL, because fortunately, the majority of people who we perform the BTL on are older women, who have families and are relatively sure of their decision,’’ the gynaecologist says.
"With the advent of fertility treatment, you have the option of doing IVF [In vitro fertilisation]. IVF can overcome the issue of tied tubes,” she adds.
“As someone ages—let’s say they reach 35 or 40 years—they may find that the urgency driving such decisions fades with time, experience, or increased exposure. They might even approach these decisions with better clarity and understanding later in life,” she says.
She likens these choices to getting tattoos: “People often get permanent tattoos in their 20s but later regret when they realise the tattoos limit their options—like joining the army. The same can happen with decisions about sterilisation. What seems like the right choice now could shift as you grow older and gain new perspectives,” cautions the psychologist.
One Reddit user, in her 20s, detailed her regrets after the procedure.
“My surgery went well, I recovered quickly, and, at first, I felt great. It wasn't until I began dating my current boyfriend that I experienced a total paradigm shift. He's amazing. He's the first partner I've ever had that makes me feel like I have a maternal bone in my body. People always told me that I would change my mind about having children when I met the right person and it made me so angry. I didn't think it could change such a strong core belief, something I had felt certain about since childhood. Looking back, I now know that a lot of my beliefs surrounding motherhood came as a direct result of my own difficult childhood and I just couldn't see it. Now that I'm in a healthy relationship with someone I fully anticipate to be my life partner, I am more than comfortable with the idea of being a mom. I would love to have a baby someday,’’ she noted.
Dr Awiti emphasises that before one decides to do tubal ligation, the process should involve consulting multiple healthcare providers and even psychiatrists.
“This ensures the decision is not influenced by temporary emotional or situational factors,” she says.
In terms of controlling your reproductive potential, the gynaecologist stresses that there are so many options readily available that are not necessarily permanent.
‘’You should only consider permanent methods after reaching a stage in life where you are completely certain of your decision. I advocate for other contraceptives which we have so many, from the simple condom. And what will a condom offer you? It also protects you against infections,’’ Dr Awiti says.
