Rachel recognizes that while helping Beth is necessary and morally good, the costs of doing so will always be hard to bear. In particular, Beth’s sterilization means that, in one crucial respect, her disability
will prevent her from living the same kind of life as non-disabled people. Similarly, Beth’s procedure also reminds Rachel about the dark history of countries like the U.S. forcibly sterilizing women with intellectual disabilities. And it brings up her own personal struggles with love, romance, and family, which largely stem from her own difficult childhood.