A woman denied sterilisation by the NHS in case she regretted her decision has had her complaint upheld by the health ombudsman.

Leah Spasova, a psychologist from Oxford, spent 10 years trying to access the procedure, but her funding request was turned down on the grounds of this potential regret and cost-effectiveness. Arguing that the same NHS body regularly funded vasectomies without using these grounds for rejection, Spasova complained to the Parliamentary and Health Service Ombudsman. On Friday, it ruled that a policy citing the “risk of regret” as a reason to refuse funding was “unfair” to women. 

What is available on the NHS?
Sterilisation for both men and women is organised by local integrated care boards, as part of NHS contraception services. Most boards routinely fund both male and female procedures, subject to certain criteria being met, but some told The i Paper that “vasectomy is encouraged or preferred over female sterilisation”. In some areas, women have to submit an individual funding request for approval.

The procedure blocks, seals or cuts the fallopian tubes, to prevent eggs from reaching the uterus, and is usually performed under general anaesthetic via keyhole surgery. Although complex procedures do exist to reverse it, they typically have a success rate of between 50% and 70% and aren’t usually available on the NHS.

In 2024-25, the NHS carried out nearly 11,000 sterilisations – a year-on-year increase of 2%. But the long-term trend is downward, with a 22% decrease in a decade. The number of vasectomies performed in 2024-25 was 26,385, 16% higher than in 2023-24.

What are the barriers to access?
Critics argue that the stricter eligibility criteria for women seeking sterilisation “amount to unequal treatment compared with men seeking vasectomies”, said The Guardian. But others say “tighter controls reflect legitimate medical concerns”, including the risks associated with a more invasive procedure.

A 2022 analysis of Dutch women put the rate of regret at about 10.5%, compared with 5.1% of men who regret vasectomies. But the rate of regret is nearly twice as high among women under the age of 30, at about 20%. NHS clinical guidance says sterilisation should be available for women, with counselling to address the risk of regret.

The Metropolitan Police is trying to bring the main suspect in the Madeleine McCann case to the UK to stand trial before the 20th anniversary of her disappearance next year. There are “numerous hurdles” to extraditing German national Christian Brückner, a Scotland Yard source told The Telegraph. But officers are trying to “amass the strongest evidence” they can, with the hope of trying him in the UK.

Only suspect
Brückner (pictured above) was named the prime suspect in Madeleine’s disappearance in 2022, when he was serving a prison sentence for raping an elderly woman. Telecoms data placed his phone in Praia da Luz around an hour before the 2007 abduction, and he had been “suspected of burgling hotel rooms and breaking into apartments and villas” in the area. In 2021, German prosecutor Hans Christian Wolters said he was “100% sure” that Brückner had murdered the three-year-old.

Despite Brückner remaining the only suspect in the case, no charges were brought against him before his release from his most recent sentence in September last year. He refused to be interviewed by the Met prior to leaving Sehnde prison.

Since his release, Brückner has “drifted around northern Germany”, said The Telegraph. He’s reportedly sleeping in sheltered housing and camping in woodland, but “rarely staying in the same place for more than a few weeks”. Although his current whereabouts are unknown, he must wear an “ankle tag” as a condition of his release, living “under constant German police surveillance”.

Legal row brewing
Scotland Yard “believes it can gather a strong enough case” for the Crown Prosecution Service to authorise charges of suspected abduction and murder against Brückner, said The Telegraph.

But attempts to bring him to British shores could provoke a “diplomatic and legal row”, said The Times. Despite the 2021 introduction of the EU-UK Trade and Cooperation Agreement – a reciprocal extradition agreement – Article 16 of the German constitution retains the right to overrule extradition of its citizens to non-EU countries. If Germany refused to hand him over, it is understood that the Met would be “committed to ensuring that he still faces charges in Germany or in Portugal”.

Beyoncé steps out at the Met Gala for the first time in a decade, before being joined by her eldest daughter, Blue Ivy, and husband, Jay-Z. The theme of last night’s fundraiser at New York’s Metropolitan Museum was “Fashion is Art”.

John Shearer / WireImage / Getty Images

Saddling up for an equestrian adventure can make for a truly unforgettable experience. From multiday desert treks to gentle countryside hacks, a horse-riding holiday can be a fun way to explore your surroundings and reconnect with nature. 

Le Barn, France
This former equestrian farm, just an hour from Paris, is now a “stylish and welcoming retreat where every room looks out onto meadows”, said Kate Johnson in The Guardian. Located in the Rambouillet forest, the sprawling property shares 500 acres with a “world-famous” horse-riding training centre. But the real draw is the weekly Whisperer’s Experience, where you can learn how to “forge a connection by working on foot with a free horse and using your body language and exercises” to “build trust”.

Reschio Hotel, Italy
Set amid the “quite outrageously beautiful” rolling hills and olive groves on the Tuscany-Umbria border, this 11th century castle is now a 36-room hotel surrounded by farm buildings, said Steve King in Condé Nast Traveller. The estate is a “noted breeding and training ground for Andalusian horses”. Even if you don’t fancy taking a lesson, “you’d be mad not to go and pay a visit to the stables and see with your own eyes these extraordinary, otherworldly creatures”.

Gleneagles, Scotland
This iconic Scottish hotel in the heart of Perthshire is one of the world’s “loveliest” spots for “golfing, relaxing and exploring the bonny lands beyond”, said Lydia Bell in Condé Nast Traveller. It’s also home to an excellent equestrian centre offering a packed schedule of horse-riding lessons and walking tours. Facilities include two covered, heated show-jumping arenas, a large livery and woodland cross-country hacking.

Winning peace in Lebanon is harder than winning war
Lorenzo Kamel on Al Jazeera
A “symbolic meeting” in Washington won’t “be enough to resolve the conflict in Lebanon”, writes historian Lorenzo Kamel. Israel’s occupation of parts of southern Lebanon is part of a “historical aspiration” for expansion. There’s “no military solution to what is really a political problem”, and “powerful actors” on both sides are fanning the flames of the conflict. Without a “new negotiated regional order accepted, first and foremost, by local powers and players”, there will be no lasting peace.

Democrats, Britain’s Prime Minister is a Warning
Samuel Earle in The New York Times
Keir Starmer’s election landslide “seems a long time ago now”, writes Samuel Earle. He’s now one of Britain’s “most unpopular leaders ever” and Labour is “headed for a historic wipeout” in local elections. US Democrats should take note: “an offer of competence, pragmatism and decency is no longer enough”. A “leader without a base” will “find the floor falling out from beneath them”, and a “campaign that relies on voter apathy will foment the political forces it purports to fight”.

Sex-crazed nudists are running wild and the authorities decline to act
Charles Moore in The Telegraph
A “sex-mad naturist’s dream” has become a “villager’s nightmare”, writes Charles Moore. An “adult-only” nudist campsite in East Sussex, called Turn a Blind Eye, is disturbing locals with “loud music and wild yells in the middle of the night”. A farmer and his young son stumbled across a female naturist “performing a sex act on a male one” in a hedgerow. Yet “timid” local authorities have been “reluctant to act” – and now “the weather is hot enough for naturists to be on the prowl once more”.