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Sterilization is an increasingly familiar phenomenon to women worldwide, and it is the most prevalent contraceptive practice in the world. Costa Rica, where the use of contraceptives is generalized, is among those countries in the world with the highest prevalence of female sterilization. In Costa Rica, female sterilization is homogeneously distributed, common among women living in rural and urban zones, as well as among those of diverse educational levels. In contrast to what one may expect given the legacy of abusive birth control practices in Latin America, the “problem” of sterilization in Costa Rica has been framed by women and doctors alike not as the “need” for curbing its use but rather as a “struggle” for broadening access as much as possible. Interestingly, current rates of sterilization have been attained in the absence of a formal program offering sterilization for contraceptive purposes and in the context of a very restrictive legal framework for its provision. It was not until July 1999 that sterilization for contraceptive purposes was explicitly regulated and permitted. Before that year, it was only so-called therapeutic sterilization that was legally allowed. Sterilization was supposed to be offered only for health reasons. Notably, successive moves intended precisely to broaden access to this surgery within the state hospital system have been realized through regulation formally restricting its provision. This sometimes counterintuitive history of the provision and regulation of sterilization in Costa Rica is analyzed.