Heather Cromarty has some interesting scars. One, no larger than a pinprick, is where she sports her nose ring. Another, on her forearm, is vicious-looking; she fell off a roof as a child and the bone pushed through her skin. She also has two large tattoos, one on each arm.

But the most important scars on Cromarty’s body are her two most recent acquisitions — one is near her navel, the other is a few inches to its left, towards her pubic bone. They are from a recent tubal ligation surgery. She will gleefully tell you that she’s been spayed.

“I think babies are nice,” says the 35-year-old. “I just don’t ever want to make one.”

The medical community is reluctant to offer sterilization procedures to young, unmarried women like Cromarty. It took multiple attempts before her request was taken seriously.

“Why is it okay for women to choose to have children, but it’s not okay for them to choose not to have children?” asks Sarah Lawrance, a master’s student in sociology and women’s studies at the University of Ottawa who has undergone sterilization.

“Why do you grill women for seeking sterilization, but congratulate women who become pregnant? People tend to think that motherhood is essential to being female, and that women’s lives will only be complete with children.”

To Lawrance, tubal ligations are a matter of control and autonomy. And while people have their own opinions, that choice should belong to the woman alone.

“You need to let people make their own decisions about how to lead their lives,” she says. “Even if you think they’re wrong.”

* * *

Tubal ligation is a female sterilization procedure that cuts, burns or blocks the Fallopian tubes, preventing the egg from travelling into the uterus. The surgery takes about an hour. While tubal ligation reversals are offered by some surgeons, the procedure is expensive and good results are not guaranteed. Before undergoing a tubal ligation, women are informed that it is considered permanent.

About 20,000 tubal ligations are performed in Canada annually; the overwhelming majority are done on women with children who wish to prevent future pregnancies. Fewer than 1 per cent of the surgeries are performed on women who never want to have children, like Cromarty.

“My family doctor refused to refer me to the gynecologist until I insisted multiple times,” says Lawrance. “My gynecologist also refused to take me seriously…I asked her if she would rather I come to her for abortions after inevitably becoming accidentally pregnant. This and the fact that I had a partner who consented to my surgery seemed to finally sway her.”

Dr. Nicholas Leyland, chairman of the obstetrics and gynecology department at McMaster University, understands the frustrations of women like Lawrance, but says there’s a fine balance between trying to do what the clinician feels is correct and respecting the autonomy and decision-making of the woman.

“From an ethical standpoint, we always try to meet the needs of the patient, but we always have to balance that with what we feel is most appropriate clinically for the particular situation,” he says.

There are currently no official guidelines on who can or cannot get the procedure in Canada (according to the Society of Obstetricians and Gynaecologists of Canada, work on a clinical practise guideline related to tubal ligation is underway, but it is not expected to be published before fall of this year). In the meantime, doctors make their decisions on a case-by-case basis. Generally, women under the age of 30 and those without children meet the greatest resistance.

“Physicians are very reluctant to offer this as a first-line procedure for women in their 20s or younger,” Leyland says. “That’s the group that is obviously high-risk for having changes in their life where they may regret that decision.”

Which is why women often go to family planning clinics with the intention of requesting a tubal ligation and end up leaving with an intrauterine device (IUD), according to Dr. Erika Feuerstein, medical co-director of the Bay Centre for Birth Control and Special Treatment Clinic.

“It’s not that we’re trying to steer them away,” says Feuerstein. “Surgery creates the potential for complication and IUDS are nearly as effective at preventing pregnancy,” she says. Failure rates for tubal ligation sit at approximately 0.5 per cent; for traditional IUDs the figure is 2 per cent.

“There’s a new . . . IUD that’s as good or better than tubal ligation,” Feuerstein says. “A lot of women choose that option. It’s not surgery. It’s easy. It’s quick.”

But IUDs aren’t the best option for everyone.

“(It) caused me three years of absolute torment,” says Cromarty, who experienced severe cramping after having her IUD inserted. It “just got worse and worse and worse.”

* * *

For Tabatha, the final straw was having an abortion at the age of 40.

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“(The tubal ligation) was something that I’d wanted to have done for so long,” she says. “I had to wait and wait and wait for them to finally give me the go-ahead.”

Tabatha, whose name has been changed, has chic, bobbed hair and gentle blue eyes. Scarring between the bottom of her nose and upper lip lend a feline quality to her face. “I was born with a double cleft palate,” she explains matter-of-factly.

In her early 20s, Tabatha learned there was a strong possibility she might pass the gene for bilateral cleft palates onto her offspring. “I didn’t want to take that risk. . . everything I had to go through. . .I don’t want to pass it on. It was very traumatic.”

She also cites financial restrictions as a reason against having children. “If I can’t give them everything that I want to give them, I’m not having them.” Relating the story of a friend who couldn’t afford to send her son on a school skating trip, Tabatha wells up.

“It broke my heart,” she says. “I grew up with not a lot of money. There were things my mom couldn’t afford to give me. I can’t do that.”

Finances did not come into play for Tabatha when it came to paying for her surgery. In Canada, tubal ligations are covered by OHIP.

The health ministry and several Ontario hospitals were unable to provide figures, but Buffalo General Hospital bills patients who undergo tubal ligation surgery $1,318, plus the cost of anesthesia.

Some might argue it’s unfair for taxpayers to cover such extreme contraceptive measures, especially since Canadians have ready access to condoms and other forms of birth control. But child-free women who undergo tubal ligations might reasonably argue they are saving the system money. The average in-patient cost for vaginal childbirth (without complications) in Ontario is around $3,000 and around $5,000 for a caesarian section.

After her abortion, Tabatha demanded that the procedure she had asked about for a decade finally be done.

“I had to really push my doctor. She kept saying, ‘What happens if you change you mind?’ And I said, ‘I’m not going to change my mind. I’ve been thinking about this since I was 25!’”

Like Lawrance and Cromarty, Tabatha found the ordeal frustrating. “It should be that if you want it, you want it. It’s as simple as that.”

“Do I have to be menopausal?” Cromarty sighs. “That kind of defeats the purpose.”

Having finally gotten her tubal ligation, Cromarty is celebrating. As an alternative to a baby shower, her friends threw her a sterility shower, celebrating her important life decision. It featured sushi, alcohol, unripened cheeses and other fetus-unfriendly fare.

Six weeks after her surgery, Cromarty emphasizes one idea: “I think it’s important for women to be taken seriously,” she says. “And I feel that we’re not.”

As she walks away, there is a noticeable lightness to her step. Her body will never be weighed down by pregnancy. Neither will her mind.