From regular pap smears to contraception, we're lucky to live in a country where healthcare is free and readily accessible to women – and with the exception of Northern Ireland, where abortions are free and legal.
But when it comes to permanent sterilisation, access can be more difficult – especially if you are in your 20s and you've never had children.
Not all women want kids. And for some, ending their fertility by tubal litigation – a procedure colloquially known as "getting your tubes tied" – is the answer to the long-term use of other contraceptives.
Issy McKenzie, now 30, was 27 when she decided she wanted the operation. She had never wanted children and had been on the pill for a long time, which was affecting her health. When she was diagnosed with chronic fatigue syndrome, she came off the pill to see if it helped her energy levels.
"While some people with CFS find that the pill actually helps them, it was the opposite for me," McKenzie says.
"Since I'd tried most other forms of contraception by then, and I'd never wanted kids, I started asking GPs for a referral, and calling round gynaecologists to find a surgeon who'd be willing to do it for someone who'd never had children."
Technically, there is no tying involved in a tubal litigation. The procedure involves blocking or sealing the fallopian tubes, which link the ovaries to the uterus and prevents the women's eggs from reaching the sperm and being fertilised.
After deciding the operation was the right choice for her, Issy faced an uphill struggle to get a referral.
"Despite the fact that I was willing to fund the operation myself, it took me a good couple of years of going back and forth and calling around to get the referral I needed," she says. "Some just dismissed me outright, some were very apologetic. One surgeon even called me back to talk at me about how I'd eventually regret it."
"Most seemed to think that I'd change my mind about children eventually, as if they somehow knew more about what I wanted than I did," McKenzie explains. "I understand why medical professionals are reluctant to do it - sterilisation reversals are difficult and expensive and there have been people who regretted their decision - but it was still pretty frustrating."
When you've exhausted all the options
McKenzie wrote and printed out a list of pre-prepared statements to take to consultations, saying she had exhausted all other options and definitely didn't want children.
"I just decided to keep going back to different GPs with my partner there for backup and handing it over until I found one who'd actually listen to me," she says.
After several years of back and forth with doctors, McKenzie finally had her tubes tied last year at the age of 29.
But why – once a woman has made up her mind to be sterilised – is it so difficult to get the operation done?
Part of the problem is that the decision by women not to have children is still a taboo. A study published in March found couples who make the choice not to have children are seen to violate social norms – and it is women who are judged the most for deciding not to procreate, as motherhood is seen as our societal duty.
Why are doctors often unwilling?
For McKenzie, being sterilised was a choice she made for several reasons – no, she didn't want children and didn't want to rely on contraception, particularly hormonal kinds that made her CFS worse.
"One of the things that really annoyed me was that people seemed to think my quality of life - the improvement in energy and mood I had when not on hormones - was less important than the remote possibility I might want children at some point in the future," she says. "It's like I was some kind of walking womb, just waiting until my biological clock finally kicked in."
"That's one of my least favourite parts of being female - the idea that my dreams for the future and all the things I want to achieve in my life are subservient to my ability to have kids."
Some doctors may be less willing to refer patients for elective surgery on the risk that they will regret the operation later in life. Although sterilisation reversal operations exist, they're not always successful and are rarely available on the NHS. McKenzie says it is highly unlikely she will regret being sterilised, but a possibility she is willing to accept.
"My personality, my life, my entire identity would have to dramatically change for me to become the kind of person who wanted children," she says.
Financial constraints
Natika Halil, chief executive of the sexual health charity FPA, says there may be another reason why it is difficult for women to access sterilisation.
"In some areas, cuts to health budgets have meant that it can be hard to access sterilisation through the NHS, or there are long waiting lists," she says.
"A survey of GPs in 2016 found that just 2% of those questioned offered the full range of contraceptive methods to patients, and more than half said there is not time in a standard contraception appointment to talk about the options."
But whether you're considering sterilisation or other forms of contraception, it is essential that you to have all the information you need to make an informed decision – to make the right choice for you.
"You should be told about sterilisation failure rates, any possible complications or reversal difficulties and the need to use contraception until the sterilisation has been confirmed as a success," Halil says.
"Choice and access to all methods of contraception is important to make sure that everyone can find a method that suits them."
