The Policy Changed — But The Inequality Didn't

Where Things Stand Now with BOB ICB 's Policy for Female Sterilisation & also Male Vasectomy as of 28 April 2026

On paper, the policy has changed.

The latest version of the policy (February 2026) moves away from the previous position where female sterilisation was “not normally funded,” and instead introduces what is presented as a criteria-based approach.

At first glance, that sounds like progress.

But when you look closely at how the policy actually works in practice, the reality is far more complicated — and still far less equal.

What Has Changed

• Female sterilisation is no longer outright defunded
• It is now conditionally funded under strict criteria
• The policy references national guidance and ethical frameworks
• It includes language about considering individual needs

On paper, this suggests alignment with clinical standards.

What Has Not Changed

The fundamental problem is still there — access is being controlled.

Under the current policy:

• Women are expected to undergo a “therapeutic trial” of Long Acting Reversible Contraception (LARC)
• Only if LARC is deemed unsuitable, ineffective, or inappropriate can sterilisation be considered
• The burden remains on the individual to prove that alternatives have failed

And this is where the logic completely falls apart.

If someone has made a clear, informed decision that they do not want children and they want a permanent contraceptive solution — what exactly is the purpose of forcing them into a “trial” of something they have already decided they do not want?

A therapeutic trial is supposed to treat something.

What is being treated here?

There is no medical condition being treated. There is a decision.

And forcing someone into a pathway of temporary contraception when they are explicitly seeking a permanent solution is not clinical care — it is gatekeeping.

• It’s the equivalent of saying:
• “You’ve decided on a permanent solution, but first you need to go through a series of temporary ones to prove that you really mean it.”

There is no rational clinical basis for that.

If the option is approved, safe, and recognised — the question should be whether the person has capacity and has made an informed decision. Not whether they have complied with a prescribed sequence of alternatives.

The Ongoing Inequality — And This Is Where It Gets Worse

At the same time that women are being put through this conditional, restrictive pathway, something very different is happening on the other side.

BOB ICB is actively working with private providers to expand access to NHS-funded vasectomy services.

As per current service information:

• Men in the region can access NHS-funded vasectomies through private providers
• In some cases, they can self-refer directly — without even going through their GP
• These services are being actively expanded and streamlined

So let’s be very clear about what this means in practice:

• Men can access permanent contraception directly, quickly, and with minimal barriers
• Women are required to go through clinical gatekeeping, trials of alternative methods, and justification processes

This is not a subtle difference.

This is a structural imbalance in how access is designed.

What This Means in Practice

What This Means in Practice

The policy has not created equal access.

It has created two completely different pathways:

• One that is patient-led, accessible, and streamlined
• One that is restricted, conditional, and controlled

And that difference matters.

Because it directly affects:

• how quickly someone can access care
• how much control they have over their own body
• and whether their decision is treated as valid from the outset

The Bottom Line

This is not a resolved issue.

It is a reframed one.

Female sterilisation remains a controlled option, dependent on compliance with a pathway that many people do not want and should not be required to go through.

Meanwhile, male sterilisation is being made increasingly accessible — even to the point of removing the need for GP involvement altogether.

That is not equality.

And it is not consistent with the principles the system claims to uphold.

So I asked NHS Thames Valley ICB Chair Dr Priya Singh to justify the new restriction

For me, identifying that the policy had changed was not enough.

The previous female sterilisation policy had already been investigated by the Parliamentary and Health Service Ombudsman. Serious failures had been identified in how the ICB had considered the evidence, patient choice, informed consent and the difference between access to female sterilisation and male vasectomy.

Yet in February 2026, women were once again being presented with another restriction: a requirement for a “therapeutic trial” of Long-Acting Reversible Contraception (LARC) before permanent sterilisation.

So I wanted to know something very simple:

I took those questions directly to Dr Priya Singh, Chair of NHS Thames Valley ICB.

I asked her whether the February 2026 policy complied with the Equality Act 2010 and Public Sector Equality Duty, the NHS Constitution, the principles established by Montgomery v Lanarkshire Health Board, NICE guidance, informed consent and bodily autonomy. I also asked how the ICB could justify continuing to place additional barriers in front of women seeking permanent contraception while access to male vasectomy remained fundamentally different.

I repeatedly asked for a clear answer and for the evidence supporting the policy.

What followed became another important chapter in this story. The correspondence continued for weeks. The policy was being reconsidered while I was challenging it. Dr Singh ultimately declined to give me the straightforward compliance answer I had requested and later closed the correspondence.

To me, that raised an even bigger question: if the Chair of the organisation could not clearly defend the restriction when directly challenged on its legal, clinical, equality and autonomy implications, why had women been subjected to it in the first place?