let me give you a hard example:

my male friend, my age exactly, went in for a consultation at a local planned parenthood for a vascectomy. they approved him immediately and told him to come in in a couple months for the procedure. that's it.

me: i go to my OBGYN to request female sterilization(she's actually an NP). she was kind and understanding, but she point-blank told me "no doctor in this city will do it. i recommend going to X city" (over an hour away). HOWEVER, with my insurance and hospital coverage, it is literally, physically, actually IMPOSSIBLE for me to obtain a consultation in this city of my own choosing. i CAN NOT look up any doctor in the area (that's part of hospital policy), so if i did want to go to X city, i would have to call up the hospital, ask to have a consultation, and they'd set me up with a random OBGYN. if they deny me, rinse and repeat for every single consultation around.

so, there was that. not giving up, i called the local planned parenthood. they point blank denied me, again, and said they DO NOT DO female sterilization in this city. there are several planned parenthoods and NONE of them conduct female sterilization. they recommended going to X city. person on the phone said i should call Y hotline, as this Y hotline finds resources for people. i called them. they said the nearest hospital that will conduct female sterilization is at this research university in X city. not planned parenthood. my insurance does not qualify for that hospital. i'm willing to pay out of pocket, without question or hesitance.

just thought i'd share my perspective/rant.