A woman denied a permanent form of birth control on the NHS over fears she might regret it, while men were allowed contraceptive procedures, has won her case with the health ombudsman.
Leah Spasova, a psychologist from Oxfordshire, spent a decade fighting to obtain female sterilisation at her local trust, a procedure that blocks or seals the fallopian tubes to prevent pregnancy. By contrast, men can undergo a vasectomy, a procedure that stops sperm from being released.
She was refused the sterilisation procedure on the NHS, with her local trust citing concerns about potential regret and cost-effectiveness. Spasova challenged the decision, taking her complaint to the parliamentary and health service ombudsman, who hears complaints about the NHS in England.
The ombudsman has issued a critical ruling against the Buckinghamshire, Oxfordshire and Berkshire West integrated care board (ICB), which had denied her funding.
Female sterilisation, or tubal ligation, is a surgical procedure that involves sealing, cutting or blocking the fallopian tubes to prevent eggs from reaching the uterus. It is usually performed under general anaesthetic via keyhole surgery and requires a few weeks of recovery. In contrast, a vasectomy is a minor outpatient procedure, typically carried out under local anaesthetic in under 30 minutes.
While both procedures serve the same purpose, permanent contraception, the ombudsman’s investigation found that the NHS was in effect treating them as different tiers of care, placing significant barriers in front of women while offering men a more straightforward pathway.
The investigation found that the ICB had denied women NHS funding based on the risk of “regret”, a criterion not applied to men seeking vasectomies. The ombudsman 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 ombudsman, 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.”
She added: “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 – 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.”
She added: “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.”
A spokesperson for the ICB said: “NHS Thames Valley accepts the findings of the parliamentary and health service ombudsman regarding historical decision‑making in this case. Since that time, NHS Thames Valley has introduced a new policy to ensure that patients who meet the criteria are able to access female sterilisation.
“As a new ICB, we are also redesigning our complaints function to ensure concerns about local services are responded to more effectively and in a timely way.”
