Woman Wins Complaint Over NHS Double Standard on Sterilization

Leah Spasova’s ten-year struggle for permanent contraception ended in a finding that exposed a gendered double standard in NHS care. The psychologist from Oxfordshire had repeatedly sought female sterilization through her local health body while the same system routinely funded vasectomies for men, turning one patient’s case into a test of whether public health policy was treating women’s reproductive choices as less legitimate.

The Parliamentary and Health Service Ombudsman said the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board acted inconsistently, subjectively and unfairly when it refused to fund Spasova’s request. The ombudsman said NHS commissioned services should operate fairly, transparently and with clear clinical rationale, and found that the ICB did not routinely fund female sterilization at the time of the refusal even though it did routinely fund vasectomy for eligible men. It also said the board failed to explain why it did not follow clinical guidance, which says sterilization should be available for women and that counselling, not blanket exclusion, should address the risk of regret.

The investigation went further, finding that the ICB applied cost arguments unevenly. Male sterilization was recommended for funding without updated cost data, while female sterilization was rejected because of a lack of recent evidence, even though older studies indicated the procedure can be more cost-effective over time. The ombudsman said regret and the availability of more cost-effective alternative contraception should no longer be used as grounds for refusal.

Spasova said she had been sent back and forth between services for years, a process that left her blocked from making her own medical decision. Her complaint also drew attention to how commissioning rules can limit bodily autonomy in practice, especially when women are steered toward long-acting reversible contraception or a partner’s vasectomy instead of being offered sterilization on equal terms.

The policy change that followed matters beyond one case. In 2024, an advisory committee took responsibility for policy recommendations for six South East England integrated care boards, including Buckinghamshire, Oxfordshire and Berkshire West. Four of those six already funded female sterilization. After Spasova’s complaint, the committee reviewed the policy, recognized the equality issue created by funding vasectomy but not female sterilization, and recommended that female sterilization should be funded. The NHS body said it accepted the findings and had introduced a new policy so patients who meet the criteria can access female sterilization.

The case lands against a wider decline in sterilization procedures. NHS England Digital recorded 10,588 sterilizations in NHS hospitals in 2023-24, down from 10,727 the year before and 14,883 in 2013-14. It also recorded 22,775 vasectomies in 2023-24, a figure inflated by about 9,000 procedures from a newly reporting provider. Paula Sussex, chief executive of the ombudsman, said the problem was not isolated and warned that similar patterns may exist elsewhere in healthcare.