A psychologist who was denied sterilisation on the NHS has successfully challenged the decision after taking her case to the health ombudsman, raising questions over how accessible the procedure should be. Age is the issue and concern about regret if “permitted” too soon.
Leah Spasova spent years seeking an operation to prevent pregnancy by blocking the fallopian tubes. Many argue that barriers faced by women, from funding refusals to stricter eligibility criteria, amount to unequal treatment compared with men seeking vasectomies, and limit bodily autonomy. Others say tighter controls reflect legitimate medical concerns, including the procedure’s relative risk, its permanence, and evidence that some patients later regret the decision.
Leah Spasova
In 2024-25, 10,793 female sterilisations were carried out, down 22% on a decade ago, while there were 26,385 vasectomies, up 16% year on year.
Charlotte Glynn, a research and innovation nurse at the British Pregnancy Advisory Service, said: “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 added: “There is an argument that it is a riskier procedure than a vasectomy, but if a woman is given the right information to make an informed decision and that is what she wants, that should be respected. In terms of cost, multiple unintended pregnancies also carry a cost. Many women struggle with the side-effects of contraceptive pills and patches.”
Glynn said men were not questioned in the same way when requesting sterilisation. “It is a form of medical misogyny,” she said. “Women are often seen as primarily defined by childbearing and reproduction.”
She described access as a “postcode lottery” and said the procedure was not always treated as essential, meaning women rarely reached the top of waiting lists. “We had one patient who had asked her GP for a sterilisation referral three times. She already had two or three children but was under 30, so was told she was too young. She later became pregnant and had an abortion. Some women feel more empowered after that experience to go back and insist they do not want more children.” Glynn concluded: “We should be making sterilisation more accessible. Like many areas of women’s health, this needs improvement.”
However, Anna Glasier, an emeritus professor at the University of Edinburgh, said women did have the same access as men. She argued: “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. “For women, long-acting reversible contraception provides a method of fertility regulation which is as effective as sterilisation, and will work for 8-12 years, – but which is instantly reversible. So for women there is a good alternative and it makes sense to offer it to them, while for men the only other methods are condoms or withdrawal.”
She concluded: “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 show 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 long-acting reversible contraception – like the IUD, hormonal coil or implant – is often encouraged, as it keeps options open.”
Spasova was refused the sterilisation procedure on the NHS, with her local trust citing concerns about potential regret and cost-effectiveness. She challenged the decision, taking her complaint to the parliamentary and health service ombuds(wo)man, who hears complaints about the NHS in England.
The ombuds(wo)man issued a critical ruling against the Buckinghamshire, Oxfordshire and Berkshire West integrated care board (ICB), which had denied her funding. found that the ICB had denied women NHS funding based on the risk of “regret”, a criterion not applied to men seeking vasectomies. The ombuds(wo)man 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.
The ombuds(wo)man, Paula Sussex, 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. This case shows the power of the patient voice. Leah complained about her experience and the ICB is now reviewing its sterilisation policy.”
The investigation also found the ICB had failed to explain why it ignored clinical guidance indicating that sterilisation should be available to women, with counselling – not blanket refusal – as the appropriate way to address potential regret.
In 2024, an advisory committee responsible for policy across six integrated care boards in south-east England, including Buckinghamshire, Oxfordshire and Berkshire West, reviewed the issue. Four of the six ICBs already funded female sterilisation. After Spasova’s complaint, the committee recognised the equality issues created by funding male but not female sterilisation 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. 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. When I asked about it in my early 20s, I was told I was too young to make that decision. That really frustrated me.”
In a letter to the trust in 2023, Spasova wrote: “The procedure is available nationwide, it is funded and it is approved by Nice, and yet it feels like the decision makers were playing ‘healthcare postcode lottery’ with people’s bodily autonomy by not offering, and defunding, the procedure in Oxfordshire.”
She said the procedure “done in an overpriced private clinic can cost anywhere between £2,000 and £4,000. Having read the committee’s meeting notes from September 2017 and others, I found that female sterilisation costs around £1,000.” She continued: “The average price for the contraceptive pill today is £22.04. If the NHS was to fund this for a woman for 20 years, the total spent would be £5,289.60.”
The ombudsman also criticised the ICB’s handling of her complaint, citing delays, unclear communication and a failure to properly engage with her concerns. The ICB has since agreed to apologise and review its commissioning and complaints processes.
Despite the ruling, Spasova said barriers remained. “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,” she said. “That’s the same as forcing men to use condoms for a ‘therapeutic-trial’ when they are requesting a vasectomy. The bottom line is: men are granted the right to bodily autonomy and healthcare on the NHS and women are not.”
SOURCES: The Guardian, by Sarah Marsh. 1 May 2026. 2pm. The Guardian, by Sarah Marsh. 1 May 2026. 2pm.