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.
Proposals challenging male authority gained strength in Costa Rica during the 20th century and, especially at the turn of the 21st century, and questioned naturalized sexual and gender identities. The effects of these discursivities are varied. The experience of feminists, of middle-class women outside these discursivities, and of women of the subaltern classes demonstrate the plurality of meanings attributed to gender relations as filtered through subjective experience. The introduction of alternative identity proposals destabilizes the established parameters of sexual and gender identities, but, at the same time, produces new conservative discursivities that limit the potential for change. Two feminist movements, one that reached its peak in the 1920s and a second that arose in the final decades of the 20th century, brought about substantive changes in female identities, revealing the power relations that underlie the discursive representation of patriarchal power as eternal and immutable. An assessment of contemporary feminism based on the experiences of its protagonists shows the movement’s significant gains as well as the challenges and weaknesses it has faced over its history, the most important of which may be how to reach beyond the sphere of well-educated, heterosexual, middle-class women. In conclusion, public discourses that have politicized gender and sexuality in Costa Rica are creatively constituted in the social world, according to what changes appear attainable at different moments of history. Carved out by actors committed to change, these discourses have achieved substantive transformations in institutional structures and subjectivities. However, present experience shows clearly that every affirmation of identity is precarious, and that the gains achieved require the ongoing, active engagement of civil society.