Female Sterilization and Epistemic Injustice

Hysterectomies, involving the removal of fallopian tubes, ovaries, or the cervix, are among some of the most common operations performed in the US and the UK. Often requested as a way of minimizing the pain associated with endometriosis, hysterectomies can also be lifesaving for women with cancer.

Recently, there has been a wave of op-eds and public accusations against medical professionals who refuse to perform these surgeries on young women, who are suffering from painful or even life-threatening conditions. 

These refusals are often justified by the concern that these young women might change their minds about having children, that their future husbands might be cheated out of parenthood or, in the case of non-binary patients, that their sexual identity might change. 

So far, these hysterectomy refusals have been criticized as denials of bodily autonomy and reproductive freedom. Yet, it is difficult to neglect that, in these interactions, some epistemic injustices might also be at play.

Uterus 

For one, the young women might be victims of testimonial injustice, which, according to Miranda Fricker, involves a speaker receiving an unfair deficit of credibility from a hearer owing to prejudice on the hearer's part. In this case, the patients’ assertions that they have understood and accepted all implications of such an operation (especially regarding the ability to procreate), are being dismissed in a way that amounts to an identity-prejudicial credibility deficit. 

Importantly, the medical professionals, deny credibility to patients based on an intersectional prejudice against young women, who are seen as immature, confused, or plainly mistaken about their reproductive decisions. They are not only denied epistemic agency, but othered, as they are viewed solely through the lens of patriarchal norms.

In addition to testimonial injustice, one might argue that young women who are denied hysterectomies also suffer from hermeneutical marginalization, wherein significant parts of lived social experience are obscured from understanding because of prejudices in collective resources for social interpretation. Historically, women, especially younger women, have been denied equal hermeneutical participation, and as a result, their lived experience of postpartum depression, sexual harassment and domestic abuse have long been obscured. 

In the case of hysterectomy denials, experiences of gynecological illness and authentic desires to remain childfree fail to be properly interpreted by the medical establishment, which functions here as a reinforcer of dominant norms linking a woman’s value to her ability to reproduce. Furthermore, these cases also indicate a compounded epistemic injustice, testimonial obfuscation, where an identity-prejudicial credibility evaluation an experience to remain unintelligible to the hermeneutically marginalized speaker. 

Thus, young women suffer a double epistemic harm – their experiences are obscured not only within the dominant discourse but also to themselves, in ways that distorts the construction of their selfhood. This explains why the denial of hysterectomies can make women doubt their own minds and desires and force them into submission to the dominant norms, regardless of the painful or life-threatening conditions they might endure.

It is my hope that considering these injustices will renew calls for embedding epistemic virtues within the medical establishment.

 

Dr Catalina Carpan is a Teaching Fellow in Political Theory at the University of Warwick. Her research explores epistemic injustice in relation to ideology and power, to show how its victims are disciplined and denied republican freedom.