Sasha spent time volunteering with children to see if she’d change her mind. It only solidified her feelings. “I didn’t dislike the kids, [but] I just wasn’t comfortable there,” she said. “I realized that parenting a young kid would just not be for me.”

She began researching permanent contraception in the form of a sterilization procedure. Sasha made the decision to not have sex until she could afford the surgery. To this day, she hasn’t been able to get one. So Sasha, who is now 25 and lives in Minneapolis, hasn’t had sex since her sophomore year of college…

Part of the problem, Sasha and others say, is how difficult it can be for young women and non-binary people to convince doctors they will not “regret” opting into a procedure that leaves them unable to have children for the rest of their lives. Women in the United States must be 21 to have their sterilizations covered by Medicaid or the Indian Health Service. Those with private insurance do not have that age restriction.

One study cited by the American College of Obstetricians and Gynecologists (ACOG) reported that around 20 percent of women who get the procedure before they are 30 feel “regretful” afterwards. That risk of regret drops down to 6 percent for women who are sterilized after age 30.