Reading the Policy: Why It Didn't Add Up

How I Investigated This Policy (And How You Can Too)

When I discovered that female sterilisation had been defunded in my area, I didn’t just accept the decision at face value. I wanted to understand whether this policy was actually lawful, ethical, and aligned with national healthcare standards.

So I approached it like an investigation.

What I found is that you don’t need to be a lawyer or a policymaker to question decisions like this — but you do need to know where to look.

Here’s exactly what I did.

1. I Started With the Policy Itself

The first step was to read the actual policy in full.

Not just summaries. Not what someone told me. The actual document.

In my case, this was:

NHS's Policies for each Trust are available and accessible online, and if you can't find them - you have the right to request them.

This is where I found the official reason for defunding female sterilisation — including claims about “regret” and “cost effectiveness.”

That’s important because once you understand the reasoning, you can test whether it holds up.

It is important for me to note here,  Cost Effectiveness is easy to investigate - that was going to be an easy and clear deductive verification of their claim.

However, I knew I had a serious case on my hands when I saw ''Regret'' on that policy.

Why?

Because if they are refusing based on ‘’ Regret ’’ they are technically and practically accepting responsibility for people’s feelings - which makes them legally liable for any choices they did or didn’t control and limit or force you into - because people can regret anything and everything.  So realistically, if the NHS was taking it upon themselves to manage your feelings in 5, 10, 30 years by making decisions for you - they take legal responsibility and you can sue them for any medical decision that led to you feeling regret.

It is unacceptable that this reason for defunding and discontinuing female sterilisation has nothing to do with its safety, reliability, or other medical concerns. It was clear as day that the decision to cut funding for women is an example of gender discrimination, patriarchal, unethical and disrespectful treatment of women that undermines women's bodily autonomy.

Consider the following:

If the NHS will argue it takes responsibility to safeguard adult's feelings about their own choices over their own body - and the ICB stands behind this, and state the need to protect people by restricting access to the birth control of their choice, I will challenge the ICB to take it upon themselves and play judge as to who is making a 'safe and unregrettable choice' of becoming a parent and responsible for another human being for life.

As Mertes states in her paper in the Journal of Medical Ethics* (2017) ‘’If physicians consider it to be their duty to Check if patients have given due consideration to possible future regrets in the case of a sterilisation request, they should equally consider it their duty to check if patients who request fertility treatment have given due consideration to the impact of parenthood on their lives.’’

In other words, and a bit of a prickly example - but if the NHS is taking it upon themselves to ensure I as an educated, healthy adult woman don't regret my decision to NOT have children,  isn't it logical for them to take legal responsibility and maybe force abortions on 15-year-olds who may (or may not) regret becoming teen moms if left to choose for themselves?

So, you can now see how their 'Regret' claim is legally and practically bonkers as a Policy statement that limits healthcare options for grown-up adult women.

Anyhow! This was clear as day from the get-go, but I needed more backing than pure 'Common Sense' because it appeared it was not so common in the NHS team that signed off on this policy.

2. I Looked at Clinical Guidelines (NICE, WHO, GMC)

Next, I checked it against clinical guidelines — the frameworks that healthcare professionals are expected to follow when making decisions about treatment, safety, and patient care.

Most people don’t know what these are, but they’re essential. In simple terms:

• NICE (National Institute for Health and Care Excellence) provides evidence-based guidance on what treatments and procedures are safe, effective, and should be available within the NHS.
• WHO (World Health Organization) sets global standards for health practices, including reproductive rights and access to contraception.
• GMC (General Medical Council) regulates doctors in the UK and sets standards around consent, patient autonomy, and decision-making in medical care.

These bodies don’t make casual suggestions — they set the baseline for what good, ethical, and lawful healthcare looks like.

So I asked: does this policy align with those standards?

Here’s what I found:

• NICE recognises female sterilisation as a valid, safe, and appropriate contraceptive option . It is not considered experimental or exceptional — it is part of standard reproductive healthcare.
• WHO includes sterilisation as a legitimate method of contraception and emphasises the importance of informed choice and access without unnecessary barriers.
• GMC guidance makes it clear that doctors must support patients in making informed decisions about their care , and must not impose their own views or restrict options without clear clinical justification.
• When you look at those together, the expectation is clear:
• Sterilisation is a recognised option, and patients should be able to choose it if they are informed and competent to decide.

What I was seeing locally didn’t match that.

The procedure wasn’t being discussed as one option among others — it was being removed altogether. That means the decision is no longer happening between doctor and patient. It’s being made in advance, at policy level, by restricting access entirely.

And that’s where the conflict lies.

3. I Checked It Against the NHS Constitution

Most people don’t know this, but the NHS has a Constitution — a document that sets out what it is supposed to stand for and how it should treat patients. Once I found the policy, I went straight to it.

Here’s what stood out to me:

• The NHS commits to equal access for all , regardless of gender
• It has a duty to provide a comprehensive service
• It must respect a person’s right to make informed decisions about their care
• It must ensure fairness and non-discrimination in how services are delivered

So I asked a very simple question: if female sterilisation is removed, is the male equivalent — vasectomy — still funded in my local NHS Trust?

I found the policy for Male Vasectomy. It was funded.

That alone raises a serious issue. One option remains accessible, the other is removed. That’s not equal access, and it’s hard to argue that it aligns with fairness or non-discrimination. On top of that, removing a valid, approved option altogether means the choice is gone before a patient can even make an informed decision.

The “Postcode Lottery” Problem

Another thing that became clear very quickly is how the NHS is actually structured.

Services are managed locally by Integrated Care Boards (ICBs) — regional bodies responsible for funding and planning care in specific areas. This means they can make decisions about what is or isn’t available in your region.

In practice, that leads to situations like this:

• A procedure is approved and funded nationally
• But removed locally , depending on where you live
• And there is no automatic referral to another area that provides it

You’re simply blocked.

To me, that’s where the system breaks down. If a procedure is recognised as a legitimate healthcare option across the NHS, access to it shouldn’t depend on your postcode. At the very least, there should be a referral pathway that ensures you can still access it elsewhere.

Otherwise, equality exists on paper — but not in reality.

4. I Looked at the Law - on the Human Right to Bodily Autonomy

If I wasn't a psychologist, I'd have been a lawyer. So, once I had checked the Clinical Guidelines and the NHS Constitution, I wanted to understand whether this would actually hold up legally. Not many people approach it this way, but I care about whether something would stand in court — not just whether it feels unfair.

And that cuts directly into something much more fundamental — bodily autonomy.

So I looked into the legality of Bodily Autonomy from a legal precedent perspective.

A legal precedent is a court ruling that sets a standard for how similar cases should be interpreted in the future. It matters because it shapes how rights are applied in real situations, not just in theory.

Here’s what I found:

• The case Montgomery v Lanarkshire [2015] established that patients have the right to make informed decisions about their treatment
• It confirmed that doctors have a duty to inform — but the decision belongs to the patient
• It reinforced the principle of bodily autonomy as a legal right , not just an ethical idea
• It shifted medical practice away from paternalism (doctor decides) to patient-led decision-making

So I applied that to my situation:

• Female sterilisation is a recognised, approved medical option
• But access to it is being restricted through a funding gatekeeping process
• That process places the decision in the hands of a panel, not the patient
• There are no clear criteria , which makes the decision arbitrary rather than clinical

That’s the conflict. That’s the point where this stopped being just a healthcare issue for me, and started looking like something that may not stand up if properly challenged - even in court.

• This is no longer about being informed and making a decision with a doctor.
• It becomes about whether someone else believes your decision is acceptable.